How common is depression in people over 65 years old?
Depression in older adults is a common problem. The exact percentage of older adults who experience depression is not known, and research studies give conflicting results. However, it appears that about one out of four adults over age 65 have symptoms of depression. In most of these cases, the person does not actually have the disease psychiatrists label as "depression," but instead have milder forms of mood problems.

What are the different forms of depression?
"Major depression" is the most severe form of depression. In major depression, affected adults usually suffer from insomnia (usually waking at 3:00 or 4:00 in the morning and not being able to get back to sleep), loss of appetite, poor energy, and loss of interest in their usual activities. The person may feel like life is not worth living, or may even contemplate suicide. These symptoms are present most days for at least two weeks.

"Dysthymia" is a long-term, less severe form of mood disorder that lasts at least two years and doesn’t usually cause as much loss of function as major depression. This is treated in the same way as major depression.

"Adjustment disorder with depressed mood" is another psychiatric term for mood symptoms that, in this case, are due to a stress in the individual’s life, such as a loss of their spouse or a move to a different living arrangement. It often improves with time.

"Depression due to a general medical condition" is a term for depressive symptoms that are caused by another health problem such as a stroke or thyroid problems. Many physical problems can cause depression. The treatment for these is first to treat the physical problem, and if the depressive symptoms are still present, treat them like major depression.

Normal grief can produce many of the same symptoms as depression. These usually improve over several months. If a person who has suffered a loss continues to have symptoms such as poor appetite, weight loss, and trouble sleeping, they may have developed a depression and could benefit from treatment.

How is depression different in older adults?
Depressed older persons sometimes do not show the same symptoms as younger adults. In particular, older adults may not feel depressed even though they have the disease we call "depression." Instead, they may lose interest in their usual activities, or have vague physical symptoms like tiredness or pain that doesn’t respond to the usual medical treatments. Another common difference is that older adults may notice significant problems with their memory when depressed, and think that they are developing Alzheimer’s disease. [NOTE TO EDITOR: Link to Dr. Burke’s discussion of Alzheimer’s disease???] (Fortunately, when memory problems are due to depression, they usually resolve when the depression is fully treated.)

How is depression treated?
There are three main forms of treatment for depression. Psychotherapy, or talk therapy, may be the only treatment necessary for some patients with mild to moderate depression. In most cases of depression, however, antidepressant medication is needed. Modern antidepressants have fewer side effects than older antidepressants. Often, a combination of antidepressant medication plus psychotherapy is the quickest and most effective form of treatment. Lastly, electroconvulsive therapy, or ECT, is often effective when other treatments have failed.

How long does it take to get better? How long do I need to take an antidepressant?
It usually takes 2-4 weeks to see improvement with antidepressant medications. Psychotherapy may take somewhat longer to demonstrate results. Psychiatrists usually recommend continuing an antidepressant medication for one year after a depressed patient is feeling better, if the depression is the first one a patient has experienced. For patients with a history of several depressive episodes in their lifetime, longer treatment is usually needed.

Isn’t depression just a fact of life for older adults?
Sometimes, it seems like depression is an inevitable part of growing older. Older adults, after all, have to endure losses, like the deaths of friends or a spouse, as well as physical problems that may come up or worsen in late life. However, it is important to not chalk depressive symptoms up to "old age." Depression is not normal, and it is not necessary for a depressed person to suffer. In the vast majority of cases, depression is very treatable.

What should I do if I, or someone I know, is depressed?
First, start with the person’s primary physician. In many cases, depression can be effectively treated by primary care physicians (internists and family physicians). If serious symptoms, such as suicidal thoughts, hallucinations, or serious weight loss are seen, referral to a psychiatrist with experience in treating older adults will likely be necessary. In those cases, inpatient hospitalization may be required to ensure the patient’s safety. Most hospitals with psychiatric units have a phone number (listed in the Yellow Pages) you can call to find out how to access their services if someone is acutely ill and needs hospitalization.