Depression in Older Adults
This leaflet is provided by the Royal College of Psychiatrists, the professional body responsible for education, training, setting and raising standards in psychiatry. They also provide readable, user-friendly and evidence-based information on various mental health problems.
This leaflet is written for people over 65 who have depression. We hope it will also be helpful for relatives, friends and carers. It covers:
- The symptoms of depression.
- How it can be helped.
- Some suggestions for further reading.
Everyone feels sad sometimes. But later life can give you more reasons to feel down. You may have to deal with:
- Stopping work.
- Having less money.
- Arthritis or other health problems.
- The death of a partner or friends.
In spite of these difficulties, older people don't feel depressed all the time - less than 1 older person in 6 feels so depressed that they or others notice. Less than 1 in 30 older people become ill with depression. But if you do, the help available will work for you just as it does for younger people.
What is it like to have depression?
Feeling low or sad is not the only sign of depression. You may:
- Lose interest in life - you can't enjoy the things you usually do.
- Feel tired for no reason. You just don't feel like doing anything. Simple things take a big effort.
- Lose your appetite - and weight.
- Feel restless - and find it hard to relax.
- Worry more than is usual for you.
- Want to avoid people.
- Feel snappy or irritable with people.
- Sleep badly. You may wake an hour or two earlier than usual and find that you can't get back to sleep.
- Lose confidence in yourself.
- Feel useless or a burden to others.
- Notice that you can't concentrate properly.
- Feel panicky.
- Lose your sexual feelings.
- Feel bad or guilty. You dwell on things from the past and may get things out of proportion.
- Think about suicide - at some point most people with severe depression will feel like ending it all.
Particular problems for older people
Physical symptoms and depression
Some physical illnesses can give you symptoms that are similar to those in depression. For example, loss of appetite or poor sleep can be caused by thyroid problems, heart disease or arthritis.
If you become depressed, you may start to get more upset by your health, even though it hasn't really changed for the worse. Treating the depression can't take away physical health problems, but it can make them much more bearable.
Confusion and memory problems
Depression, worry and anxiety can affect your memory and make you feel confused. You may worry that you are suffering from dementia (a permanent loss of memory) when it is actually just depression.
A new sense of loneliness
Living alone does not automatically make you depressed. But feeling more lonely for no obvious reason may be a sign of depression.
If you have strong feelings of depression, do take them seriously. They are not a sign of weakness, but you may need to get some help.
How do you know when it's time to get help?
If your feelings:
- Are worse than you would expect.
- Have gone on for several weeks.
- Interfere with your life.
- Mean that you can't face being with other people.
- Make you feel that life is not worth living.
- Worry you are causing concern to friends or family.
- Include thoughts of harming or killing yourself.
What should you do?
Talk to your GP. They are quite used to helping people with depression and will know what to do. You are not wasting your GP's time by asking for help. If you can't get out, ask your GP to see you at home. You may find it helpful to take a friend or relative with you when you see your GP.
I don't want to bother the doctor - depression isn't a real illness
Older people tend to think more about physical problems than about feeling depressed. You may have been brought up not to bother the doctor unless you have a physical complaint. Sometimes the first sign of depression can be a constant worry about having a physical illness, even when your doctor can't find anything wrong with you. If he or she tells you that you are depressed, it may feel as though you are not being taken seriously. This isn't the case. Depression can be treated just like any illness.
Why do people get depressed?
When we are depressed, we tend to blame ourselves; this is because depression makes us see things in a very negative way. We may start to blame ourselves for things that we are not responsible for.
Painful events. Depression can come out of the blue. More often it is triggered by something, like the death of a partner or close friend. Some of us are just more likely to get depressed when faced by a difficult or painful situation - it's our temperament. Women seem to be more likely to get depressed than men, but men may just find it harder to talk about.
Past depression. You are more likely to get depression if you have had it before.
Physical illness can make you feel depressed, such as a problem with the thyroid gland. Your doctor can check this.
Any physical illness can trigger depression. This can be sudden, like a stroke, or long and disabling, like Parkinson's disease. It may be several illnesses which have taken their toll over the years. Although this may make the depression more 'understandable', it doesn't mean that it can't be helped. This type of depression often responds very well to treatment.
Medicines. Depression can be caused by some medications. You can ask your doctor or pharmacist about this.
- Ask for help: it's the same at any age, you don't have to put up with being depressed. Tell your GP how you feel.
- Keep active: it can be hard to get out regularly because of physical problems, but it's worth doing. We know that if you keep up some regular physical exercise (even just walks), you tend to feel better. And if you are alone at home, you are more likely to brood on things, which can make you feel even worse.
- Stay connected: it helps to keep your mood up by:
- keeping up with hobbies and interests
- staying in touch with friends and family
- visiting your local library or local lunch clubs and day centres
- Try to eat properly: if you lose your appetite, it's easy to lose weight and run short of important vitamins and minerals. Older bodies cannot adjust as well as younger ones - so this can really affect your health. Beware of stocking up on chocolate and biscuits - these are quick and easy to eat, but they don't have the vitamins and minerals to keep you feeling well.
- Remind yourself that depression is an illness - not a sign of weakness. You are not being lazy or letting other people down.
- Tell someone if you feel so low that you have thoughts of taking your own life.
- Don't keep your feelings to yourself. Talking to somebody does help.
- Watch your drinking. Alcohol can make depression worse. It can also react with any tablets you are taking.
- Try not to panic about not sleeping properly. It will get better when the depression lifts.
- Try not to change the tablets you are on without discussing it with your doctor. If your tablets have side-effects, tell your doctor or nurse.
- Be kind to yourself - you may need to change your routine while you are unwell.
- Try not to think that depression causes dementia. It doesn't.
Treatments for depression
It can help to talk to a good listener. This could be a friend, a relative, a volunteer or a professional. If this is not enough, professionals can offer special ways of talking which include:
Psychotherapy: which helps you to see how your depression may be connected with what has happened to you in the past.
Cognitive Behavioural Therapy: which helps you to see how some of your ways of thinking may be making you depressed. It then helps you to think in more realistic ways that make you feel better.
Are there problems with talking treatments?
They are very safe. But, sometimes psychotherapy can bring up unhappy memories from the past. A good therapist will know how to deal with this. If you have concerns, you should discuss them with your GP or therapist.
Your GP or another professional can arrange treatments like these, although there may be a waiting list. Local organisations and charities may provide counselling or talking therapies free of charge. Ask your GP what is available locally.
If your depression has been triggered by bereavement or problems in a relationship, then bereavement counselling or marriage therapy can help.
If you are depressed and have poor sleep, poor appetite and loss of weight (or over-eating and weight gain), or the depression has gone on for a long time, your doctor will often suggest an antidepressant. About 50-60% of people who take these tablets will find they help. There are several types of antidepressant now available, so it should be possible to find one to suit you.
Do antidepressants have side-effects?
You may feel sick or more anxious over the first few days, but these effects usually wear off. Some may make you sleepy or give you a dry mouth. They can sometimes interfere with other medicines, but your doctor will be aware of this.
In older people, antidepressants can lower the amount of salt (sodium) in the blood - this can make you feel weak and unsteady.
About 1 in 3 people can get withdrawal symptoms if they stop these medicines suddenly. So it's best to come off them slowly. To find out more, read our leaflet on antidepressants.
Antidepressants take 1 or 2 weeks to start working. You may find that it takes 6 to 8 weeks for them to really make a difference. Don't drive if they make you sleepy or if they slow down your reactions - if this happens, mention it to your GP.
Many older people are already taking medication. If you add an antidepressant, you may find it hard to keep track of which tablet you should take, and when you should take it. To help with this, your doctor or chemist can give you a special box, or blister pack. This has all the tablets set out in separate compartments for each time and day of the week.
St John's wort
This is a herbal antidepressant that you can buy from a chemist without a prescription. It has fewer side-effects than prescribed antidepressants, but is not effective in more severe depression. It can be harmful if taken with some other medications - so, if you are taking other medication, ask your GP about this.
You may become depressed because you are living in poor housing, can't keep your home as you would like it or you don't feel happy where you live. If so, a social worker can help you to get advice on financial or practical support - or even moving house. But do be careful, it is easy to make a bad decision about moving when you are depressed. It is usually best to put off big decisions like this until you are feeling better.
Professionals can also help you find ways to spend time with other people. This can be important because it's easy to lose touch with people when you are depressed. There are lunch clubs, day centres and support groups where you can go. It's really important to talk with or just to meet other people. It will help.
Which treatment is best?
Everyone can try the simple steps in this leaflet. Talking treatments and antidepressants work equally well. Your GP is more likely to recommend antidepressants if your depression is severe, or has gone on for a long time.
Antidepressants work a bit faster than talking treatments. Some people prefer talking treatments, whilst others prefer tablets. You can have both at the same time. Your GP will be able to give you advice. It may also help to talk over the options with your family or a close friend.
What if depression is not treated?
Most people will get better, after weeks, months or even a year or two, but the shorter the depression lasts, the better. The simple steps outlined in this leaflet may be enough to help you feel well again. If the depression is so bad that you are not eating or drinking enough, you can become dangerously ill. It may give you thoughts of suicide.
Seeing a specialist
Although most people get better at home with these treatments, some people do not. If this happens, your GP may ask a specialist to see you for some expert advice. That does not mean that people think you are 'mad'. Your GP may need a second opinion or advice about the best treatment for you.
In Britain most places have psychiatrists who specialise in helping older people with depression. They usually work as part of a specialist mental health team, so you will usually see a nurse or a social worker first.
The first interview with someone from the team takes about an hour. If you are depressed, you may find it difficult to remember some of the details of how it all began. If so you can ask a friend, neighbour or relative to be present with you. It can also help to write down your ideas before the interview.
Going into hospital
If you are very unwell - perhaps unable to eat or drink, or have tried to kill yourself - you may need the safety of a hospital. Only a small number of people with depression become this unwell.
Nobody wants their depression to come back again. To stay well, it is best not to stop the antidepressants until your doctor advises you to - even if you have been feeling well for a while. There's a chance of the depression returning if you stop taking your tablets too soon.
If your general health is good and this is your first depression, you will probably need to stay on the tablets for 6 to 12 months. If you have already had depression several times, your doctor may recommend that you stay on an antidepressant for longer.
Do go through the section on 'Helping yourself' above. These things will all help you to stay well - and to feel that you have some control over what is happening.
For relatives and friends - how can you help?
- You may be the first person to notice the depression. Encourage them to get help. Tell them that depression is quite common, it can be treated and that they will get better. They may need to be reassured that they are not "going mad". You can suggest that they see their GP - and offer to go with them.
- People with depression get tired easily. Try to offer some practical help, like shopping or cleaning for them. They may need reminding to eat properly.
- Don't force them to talk. Just being with someone is often helpful.
- Don't push them into doing things. It can help to get out and do some gentle exercise – but it may not help if you have to nag them to do it. In fact, people will often dig their heels in if they feel they are being put under too much pressure. It may be more acceptable for you to offer to go with them to something they want to do - a lunch club, a day centre, library or interest group.
- Be patient. Depression can make someone constantly ask for reassurance or become convinced that they've got something physically wrong with them. It's often because they are frightened or don't understand what is happening to them. Reassure them as much as you can and try to spend time listening. You may need to reassure them that they are not "losing their mind".
- Don't be embarrassed to ask if they have felt suicidal. Most people who feel like this are just relieved when someone asks about it. Talking about it will help.
- You can become exhausted while caring for someone with depression - and then it is important to ask for help yourself. The specialist mental health team can give you a break by arranging for them to go to a day centre or day hospital. They are also there for you to talk to.
- Finally, try not to make decisions about housing or accommodation when someone is depressed. They may put pressure on you and say that how they feel is all to do with where they live. But things are not usually that simple. People who move when they are depressed may regret it once they are better. Remember that social services may be able to help with self-care, meals and finances.
- Don't judge and do be supportive - depression is an illness which can be helped.
- Wilson K, Mottram P, Sivanranthan A, Nightingale A. Antidepressants versus placebo for the depressed elderly (Cochrane Review). In: The Cochrane Library, Issue 4, 2001.
- Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder. Mather AS et al. (2002) British Journal of Psychiatry, 180,411-415.
- Cross-cultural comparison of depressive symptoms in Europe does not support stereotypes of ageing. Copeland JR et al. (1999) British Journal of Psychiatry, 174,322-329.
Content used with permission from the Royal College of Psychiatrists website: Depression in Older People (August 2014, due for review August 2016). Copyright for this leaflet is with the Royal College of Psychiatrists.
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