Merck Manual

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Spotlight on Aging: Depression

Spotlight on Aging: Depression

Depression affects about 1 of every 6 older people. Some older people have had depression earlier in their life. Others develop it for the first time during old age.

Causes of Depression in Older People

Some causes of depression may be more common among older people. For example, older people may be more likely to experience emotionally distressing events that involve a loss, such as the death of a loved one or a loss of familiar surroundings, as when moving away from a familiar neighborhood. Other sources of stress, such as reduced income, a worsening chronic illness, a gradual loss of independence, or social isolation, may also contribute.

Disorders that can lead to depression are common among older people. Such disorders include cancer Symptoms of Cancer At first, cancer, as a tiny mass of cells, causes no symptoms whatsoever (see also Overview of Cancer). As a cancer grows, its physical presence can affect nearby tissues (see also Warning Signs... read more , heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or heart attack (myocardial infarction), depending on the location and amount... read more Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) , heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) , thyroid disorders Overview of the Thyroid Gland The thyroid is a small gland, measuring about 2 inches (5 centimeters) across, that lies just under the skin below the Adam’s apple in the neck. The two halves (lobes) of the gland are connected... read more , stroke Ischemic Stroke An ischemic stroke is death of an area of brain tissue (cerebral infarction) resulting from an inadequate supply of blood and oxygen to the brain due to blockage of an artery. Ischemic stroke... read more Ischemic Stroke , dementia Dementia Dementia is a slow, progressive decline in mental function including memory, thinking, judgment, and the ability to learn. Typically, symptoms include memory loss, problems using language and... read more , and Parkinson disease Parkinson Disease (PD) Parkinson disease is a slowly progressive degenerative disorder of specific areas of the brain. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone... read more .

Depression Versus Dementia

In older people, depression can cause symptoms that resemble those of dementia: slower thinking, decreased concentration, confusion, and difficulty remembering, rather than the sadness people tend to associate with depression. However, doctors can distinguish depression from dementia because when depression is treated, people with depression regain their mental function. People with dementia do not. Also, people with depression may complain bitterly about their memory loss and rarely forget important current events or personal matters. In contrast, people with dementia often deny memory loss.

Diagnosis of Depression in Older People

Depression is often difficult to diagnose among older people for several reasons:

  • The symptoms may be less noticeable because older people may not work or may have less social interaction.

  • Some people believe that depression is a weakness and are reluctant to tell anyone that they are experiencing sadness or other symptoms.

  • The absence of emotion may be interpreted as indifference rather than depression.

  • Family members and friends may regard a depressed person's symptoms simply as something that is expected as people get older.

  • The symptoms may be attributed to another disorder, such as dementia.

Because depression may be difficult to identify, many doctors routinely ask older people questions about their mood. Family members should be alert for subtle changes in personality, especially lack of enthusiasm and spontaneity, loss of sense of humor, and new forgetfulness.

Treatment of Depression in Older People

Selective serotonin reuptake inhibitors (SSRIs) are the antidepressants used most often for older people who are depressed because SSRIs are less likely to have side effects. Citalopram and escitalopram are particularly useful.