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, heart attack, heart failure, thyroid disorders, stroke, dementia, and Parkinson disease.

Depression Versus Dementia

In older people, depression can cause symptoms that resemble those of dementia: slower thinking, decreased concentration, confusion, and difficulty remembering. 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 evidence that the person is getting 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.