Depression

Basic Facts

What is Depression?

Everyone feels sad from time to time. But depression is different. It’s more than just a case of the blues. Depression is a medical problem. It is a mood disorder that can interfere with all aspects of your daily life. It can interfere with sleep and cause long-term sadness, anger, frustration, and feelings of hopelessness or loss. Depression can drain your energy and interfere with your ability to work and have healthy relationships and a satisfying social life. Depression can even lead to suicide. For all these reasons, you need to recognize and take your depression seriously, and get appropriate treatment right away.

How Common is Depression?

There are almost 50 million Americans age 65 and older. National surveys find that between one and two percent of them suffer from major depression, with more women than men reporting that they are depressed. However, the numbers are likely higher because older adults, especially men, are less likely to admit or even realize that they are depressed. Another 10-15% of older Americans have milder forms of the illness. Of older adults who have completed suicide, an estimated 75% were probably clinically depressed when they did so. There is an alarming frequency of depression and suicide in widowed men 70 years old or older.

Common Types of Depression

Depression comes in many forms. It ranges from mild, temporary periods of sadness to severe, persistent depressed mood with poor functioning on a daily basis. The most common forms of depression are described below.

Major depression

Major or “clinical” depression is the most severe, persistent type of depression. This depression occurs daily for at least 2 weeks.  However, most older adults suffer much longer before they realize that something is wrong. As much as 5-8% of people with major depression complete suicide. If you have symptoms of major depression, consult your healthcare provider immediately.

Call your healthcare provider right away if you have frequent crying spells for little or no reason, or if your depression is disrupting work or family life.

These three forms of major depression are relatively common in later life.

  1. Depression associated with dementia. Some symptoms of major depression are similar to symptoms of dementia.  This is another reason why anyone with signs of depression should see a healthcare professional. 
  2. Depression associated with physical illness.  If you are suffering from a chronic disease such as diabetes, or have a serious health problem such as cancer or heart disease, you have an increased risk of depression. Medications that you may be taking to treat these illnesses may also cause side effects that contribute to depression. The diagnosis of depression in physically ill older adults is complicated by the overlap among symptoms of major depressive disorder and physical illness. In either case, when symptoms are disabling, treatment should be offered.
  3. Depression associated with bereavement.  As we get older, we are more likely to face the loss of family and friends. When you lose someone you care deeply about, you run an increased risk of becoming depressed.  Of course, grief is an appropriate response to loss.  However, a major depression may be at hand when the grief response is out of proportion to or lasts longer than what would generally be expected, or when there is a past history of depression. Prolonged grief should be brought to the attention of a healthcare provider.

Psychotic depression

People with severe depression may experience hallucinations or delusions.  Hallucinations are when you see or hear things that are not really there.  Delusions are when you have difficulty with reality. Some people may experience paranoia or feel very suspicious, such as having feelings of worry that other people are trying to harm them. Often people may believe they are being poisoned. This type of psychotic depression is most common in severe types of depression and towards the end of life.

Minor (sub-clinical) depression

About 25% of older adults have milder symptoms of depression. Although this "minor" or subclinical depression is less severe than major depression, it can still cause problems. This form of depression has been linked to poor health, more visits to the doctor, difficulty functioning, decreased social activity, and early death.

Seasonal depression

If you feel particularly depressed during the winter, you may have seasonal depression (also called Seasonal Affective Disorder or SAD). This type of depression usually occurs during the winter and lasts about two months. If the pattern repeats for 2 years or more, your healthcare provider may diagnose you with SAD.

Bipolar disorder

Bipolar disorder (previously called “manic-depressive disorder”) involves periods of major depression that alternate with manic episodes. During the manic periods, patients are unusually high-spirited, talkative, and hyperactive for a week or more.  They may have feelings of inflated self-esteem, grandiosity, increased sexual desire, and do not sleep as much as they normally do. They may spend money wildly and have racing thoughts. They may also have paranoid delusions. Older adults may be irritable or agitated rather than high-spirited and grandiose.

 

Last Updated September 2020