By 2020, depression is predicted to be the second-leading cause of disability in the world, according to the World Health Organization.
Depression is also highly recurrent. Those who suffer from a first episode of depression have a 40 to 60 percent chance of having another episode. Those with two episodes of depression have a 60 percent chance of recurrence and, for those with three episodes, the risk is as high as 90 percent.
Importantly, studies have shown that rates of adequate treatment are low, with only 22 percent of those seeking treatment actually seeing a specialist. This translates into huge public health costs in both healthcare and disability.
While the typical age of onset for depression is around 30, depression is one of the most common psychiatric disorders in older adults. As the geriatric population in our country grows, the problem of late life depression will require increasing attention.
Older adults, particularly those over age 65, may be more vulnerable to developing depression as they experience major life stressors, such as losing a spouse or friends.
In addition, their health concerns may limit their ability to engage with others, leading them to feel more isolated and more vulnerable to developing depression or depressive symptoms.
As their social circle starts to shrink, so does their support system. As a result, the impact of depression on this population can be even greater, as they may be less likely – or able – to seek help.
Does depression worsen with aging?
There is a lower prevalence of depression in those 65 years and older, but this may be due in part to early mortality in this vulnerable population, or discomfort with admitting to having psychiatric problems.
Even though mood disorders are less common, the consequences of late life depression are severe, including increased healthcare costs, morbidity and mortality. Older adults are more likely to complete suicide compared to other age groups.
The mistaken idea that feeling sad is part of normal aging contributes to the under diagnosis and treatment of depression in older adults.
What are the symptoms of depression?
Symptoms that are persistent and interfere with daily life can include:
- Feeling sad, down or depressed
- Loss of interest or pleasure in activities the person used to enjoy
- Weight loss or change in appetite
- Difficulty sleeping or oversleeping
- Trouble with concentration and/or decision-making
- Energy loss and fatigue
- Feeling fidgety/restless or very slowed down
- Feelings of worthlessness or inappropriate guilt
- Thoughts of death or suicide
Depression may be linked to a variety of causes, including genetic, environmental, psychological or biochemical factors.
Do the causes of depression change as someone ages?
There is no evidence, to my knowledge, that causes of depression change with age. One exception, however, would be mood disorders specific to late-life, such as vascular depression or affective syndrome of Alzheimer’s disorder.
What do you recommend for older adults who may be experiencing depression?
With older adults, it’s important to diagnose and treat the depression while ruling out other medical explanations that could be causing problems, such as symptoms of mild cognitive decline.
Treating late-life depression can offset the impact. In one study, older adults who responded to treatment lived an average of five years longer and had reduced healthcare costs.
There is some evidence that older adults tend to prefer psychotherapy as a treatment option, but the important thing is to get connected with a mental health specialist if you, or someone you know, is experiencing these symptoms.
Sophie Lazarus is a psychologist at The Ohio State University Wexner Medical Center and an assistant professor of psychiatry at Ohio State’s College of Medicine.