Some people consider depression to be a normal part of aging. I’ve lost my life partner, my best friend, my health, my home, my ability to function, my money,my pets. It’s normal to be unhappy. It’s just a part of aging. 

It may be normal to be sad, disappointed and stressed about losses. It is not normal for this sadness to linger, to not care, to feel nobody cares, to shut down, to feel isolated, or quit. Depression is not normal and it need not be a normal part of aging.

According to the February 2008 issue of the Harvard Mental Health Letter, about 1% to 5% of elderly people living in the community suffer from depression, 12% of hospitalized people are depressed, 14% of people receiving in house services are depressed, 29% to 52% of elderly people residing in nursing homes are depressed, as are 39 to 47% of those being treated for cancer, heart attack or stroke.

Some people are genetically predisposed to depression and changing life circumstances can trigger the depression and or anxiety. Unfortunately, many times, depression goes undiagnosed. Left untreated, depression increases the likelihood of further disability, nursing home placement, or death.

The risk of suicide increases with age. White males over age 85 have the highest suicide risk in the United States. The overall suicide rate is 11 per 100,000 people. For those 65 or older, that figure rises to 14 per 100,000.   According to the Centers for Disease Control and Prevention, older adults are less likely to seek help and are more lethal in their suicide attempts.

The elderly manage depression differently than younger people. With the aging population, there are more than likely coexisting medical problems, medication side effects, as well as the natural aging process that can mask depressive symptoms.

Some coexisting medical problems include cardiovascular disease and dementia. Twenty-five percent of people who have a heart attack or who undergo cardiac catherization suffer from depression prior to the attack or treatment. Twenty percent of people who suffer stroke develop major depression afterwards.

According to the February 2008 issue of the Harvard Mental Health Letter, elderly people who are depressed are four times as likely to die within four months of a heart attack as those without depression. Vascular depression occurs when blood vessel pathology disrupts normal communication pathways in the brain. With this, elderly people experience greater disability and cognitive impairment than other people with depression. These people are less insightful and feel apathetic, agitated, and guilty.

The tricky part with elderly is that some people seek help for the less typical depressive symptoms that initially suggest other types of medical problems. Some people complain of somatic symptoms such as heart palpitations, restlessness, fatigue, tremors, body aches and pain, nausea, vomiting, dizziness, shortness of breath, fainting, heavy perspiration, or facial flushing. Some of these symptoms could be related to depression and or anxiety.

People might report cognitive problems such as poor concentration or poor memory. There is a difference between depression and dementia.
Decline in mental functioning is more rapid with depression than with dementia. People who are depressed are less often disoriented. People with depression have difficulty concentrating, while those with Alzheimer’s have short-term memory problems. Writing, speaking, and motor skills are usually not impaired in depression.

Classic symptoms of depression include persistent intense sadness and despair, sleeplessness, appetite disturbance, tearfulness, hopelessness, helplessness, irritability, and morbid preoccupation with death. Stigma also plays a large role with depression. Today’s elderly grew up in an era when emotional problems were stigmatized even more than they are now. Remember the words “crazy,” “insane asylum,” “hardening of the arteries,, and “lunatic”? Elderly will be more apt to report physical complaints rather then depressive complaints even though they feel unhappy.

Consequently, it is important to notice all physical health problems and medications to determine if there are contributing depressive symptoms.  Sometimes treating the medical problem will alleviate the depression but other times people will need medication, psychotherapy, or both to treat the mood disorder.

Commonly prescribed antidepressants include Celexa, Prozac, Wellbutrin, Remeron, Effexor, and Cymbalta. Primary medical doctors can prescribe the appropriate medication for each individual. These medications are not addictive.

Counseling alone may help to decrease symptoms of depression and would be helpful for those with mild depression. Combining counseling and medication works best for those with more severe forms of depression.

There are various techniques used in counseling sessions to decrease painful symptoms. The person might be taught to recognize distorted self-critical thoughts and then work with the counselor to transform the negative habitual thinking and learn to accept the idea that some events are beyond their control.

Some elderly are preoccupied with death, a chronic medical condition, a significant loss, and the horrible feeling that nobody cares. To help with this kind of pain, notice the present moment even if the moment is about the painful thought. Trying to escape from or to be preoccupied with these intense painful thoughts and feelings can only make them worse. 

If the thoughts and feelings are noticed and accepted, the intensity decreases. The feeling and thought can be watched and one can learn to notice how sadness feels in the body, how it can come and go with intensity. One can learn to live with the sorrow of the loss, but can continue to enjoy life and the desired moment. Remember that thoughts are just thoughts. Notice them. Notice, and then come into the moment with mindful acceptance. 

Suffering can give rise to compassion, wisdom and well-being. The essence of what it means to be happy and healthy in old age is to discipline oneself to live in the moment and plant the seeds of positive emotions as one faces the challenges of old age.