Later-life Depression

Depression In Older Adults

Growing older is not always easy. Changes, both emotional and physical, can be debilitating. Coping with illnesses and disabilities, the loss of loved ones, and adjustments to personal lifestyles are just some of the many challenges that older adults face. Many must cope with these issues while simultaneously battling depression.

What causes later-life depression?

Later-life depression occurs after the age of 60. While prevalent, it is not necessarily part of the aging process. Indeed, it is a myth that you are depressed because you are old. The reality is that later-life depression may be a recurrence of prior depressive or bipolar episodes, or a common co-occurring illness with other medical illnesses such as heart disease, arthritis, stroke, or diabetes. For example, about 30% of stroke patients develop some form of depression following their first stroke. Depressive feelings do occur as a reaction to illnesses, but just as commonly, where vascular disease or other medical changes are present—it may occur because of alterations in common brain pathways.

For some, later-life depression seems to start as a bereavement that gets worse over time. Grief and depression can be difficult to differentiate. The loss of a loved one is a major stress and may lead to depression for those with vulnerability to depression. As with all mood disorders, genetics can play a role, so it is important that clinicians seek to identify those with strong genetic predispositions by asking about family history.

What are some of the effective ways to prevent or moderate later-life depression?

Regular activity and exercise, including walking
Good nutrition with lots of fruits and vegetables, and limited alcohol
Maintaining a regular sleep schedule and minimizing extensive daytime naps
Getting outside when it is sunny, especially in the morning, to help adjust brain chemistry
Positive, consistent social engagement with friends and family members
Easing into retirement and filling free time with volunteering or hobbies
Brain and memory-stimulating activities like reading, cross-word puzzles and sudoku
Limiting several major life changes from occurring simultaneously (moves, job changes and others) as much as possible
Engaging in practices such as yoga or meditation that promote “mindfulness” (being aware of negative thoughts without getting caught up in them) and avoiding rumination (going over and over problems in one’s mind in a non-productive way)
Using a strong support network of family, friends and co-workers
Management of vascular risk (preventing stroke, heart disease or diabetes complications)

How is later-life depression identified?

Later-life depression can be a challenge to diagnose. In a large number of cases, an episode in later-life is the first the patient has ever experienced. Some symptoms overlap with medical illnesses, making the depression harder to recognize. The first onset of depression in later life can be very hard on individuals and their families, especially those who have not been previously exposed to anyone with this condition. Older individuals may be reluctant to acknowledge their symptoms because of stigma and a lack of understanding that depression is a real brain illness.

What symptoms of later-life depression are specific to this form of depression?

Decreased participation in activities that were previously enjoyed
Changes in eating habits
Changes in personal hygiene
Neglect of the home
Social isolation/refusing to join activities or go out
Forgetfulness

How is later-life depression treated?

The good news is that effective treatments can work well for all ages. Those proven beneficial for young adults are also beneficial in aging adults, which includes psychotherapy. Many older adults respond well to cognitive behavior therapy (CBT), and interpersonal therapy (IPT), interventions that focus on problem solving, practical strategies, and relationship issues. Expert guidance may be needed for how to best use pharmacologic treatments for older patients since metabolism differences and interactions with other medications create unique medical considerations. Close collaboration with physicians is an essential part of any treatment plan. Holistic therapies such as meditation and yoga can also help bolster functioning of older adults. For the most severe cases of depression, older adults might require electroconvulsive therapy (ECT) or newer forms of neuromodulation (rTMS or VNS) that don’t cause memory loss.

How can families and loved ones help?

Later-life depression affects everyone. Other family members often identify the changes in their loved one first, noticing their troubles with enjoyment, anxiety, sleep, irritability, or loss of interest in their normal activities. A strong support system is important for everyone experiencing depression but especially crucial for older adults who might not be as mobile or need help taking care of themselves. Family and friends can provide companionship and make sure that older adults with depression receive effective care and follow-up treatment. They can also help to educate their loved one and others about the biological nature of depressive disorders. Describing depression or bipolar disorder matter-of-factly as a medical problem helps reduce stigma. Family members often need to initiate connections with area agencies that provide elder care and be a “therapeutic constant” in the life of their loved one when so many other changes are taking place.

What are some community resources for families?

The older adult’s primary care physician is a good first step. The physician can decide if treatment is needed, what type of treatment, and if a specialized referral is needed.
University of Michigan Geriatric Psychiatry Clinic and The Geriatric Center (734) 764-6831
Area Agency on Aging (toll free number and website). Has an eldercare locator to provide local assistance, information and referral services including friendly visitors, telephone reassurance.
Geriatric Mental Health Foundation web site: online information, resources and nationwide referrals for the treatment of late-life depression

Program for Positive Aging

Reducing the Impact of Depression and Other Mental Disorders in Later Life

The Program for Positive Aging is a new initiative being spearheaded by leaders at the U-M Depression Center and Department of Psychiatry, and the U-M Geriatric Center. The new program proposes to become a regional and national leader in the field of geriatric mental health and is being led by Helen C. Kales, M.D., an Associate Professor of Psychiatry and Director of the Later-Life Depression Program at the University of Michigan Depression Center and Department of Psychiatry.

If you would like to learn more about the Program for Positive Aging or find out how you can support it, please visit the Program for Positive Aging web site.