Depression is a medical illness in which a person has feelings of sadness, discouragement, and a lack of self-worth.

Depression can be caused by the loss of a spouse or close friend, chronic pain and illness, difficulty getting around, frustration with memory loss, trouble adapting to a life change such as moving from a home to a retirement facility, or changes within the family.

Depression can also be a sign of a medical problem. It may be complicated by brain disorders that occur with age, such as Alzheimer's disease.

Depression in the elderly is a widespread problem that is often not diagnosed and frequently undertreated. Many older people will not admit to the signs and symptoms of depression, for fear that they will be seen as weak or crazy.

Symptoms of depression include:

• Depressed or irritable mood
• Feelings of worthlessness or sadness
• Loss of interest or pleasure in daily activities
• Temper, agitation
• Change in appetite (usually a loss of appetite)
• Change in weight
  • Unintentional weight loss (most common)
  • Weight gain
• Trouble sleeping
  • Daytime sleepiness
  • Difficulty falling asleep (initial insomnia)
  • Waking up many times through the night (middle insomnia)
  • Waking up early in the morning (terminal insomnia)
• Fatigue (tiredness or weariness)
• Aches and pains
• Difficulty concentrating
• Memory loss
• Abnormal thoughts, excessive or inappropriate guilt
• Irresponsible behavior
• Abnormal thoughts about death
• Thoughts about suicide
• Plans to commit suicide or actual suicide attempts

If you have these symptoms every day for more than 2 weeks, you likely have depression.

Depression in the elderly may be hard to detect because of several factors. Symptoms such as fatigue, appetite loss, and trouble sleeping also can be part of the aging process or a medical condition.

A physical exam will help determine if a medical illness is causing the depression. A psychological evaluation and other tests may be needed.

Blood tests may be done, including:

• CBC
• Blood differential
• Thyroid function tests
• Liver or kidney function tests

Sometimes depression can be helped by relieving loneliness through group outings, volunteer work, or having regular visitors.

Treating the underlying medical conditions or stopping certain medications can relieve the symptoms of depression.

Antidepressant drug therapy has been shown to increase quality of life in depressed elderly people. These medications are carefully monitored for side effects. Doctors usually prescribe lower doses of antidepressants for older people, and increase the dose more slowly than in younger adults.

Talking through problems (psychotherapy) with a psychologist, psychiatrist, or other therapist is also an effective treatment. In cases of moderate-to-severe depression, people may get the best results by combining psychotherapy with antidepressant medications.

Neuroleptic medications can help treat agitation in some people. Electroconvulsive therapy (ECT) can be used in people who are severely depressed if other treatments don't work.

Depression can respond to medical treatment. If it is not detected, depression can lead to complications. The outcome is usually worse for people who have limited access to social services, or to family or friends who can help them stay interested in activities.

Depression can be complicated by Alzheimer's disease or other forms of dementia. It also can complicate other medical conditions in the elderly. There is a high rate of suicide among elderly people with untreated depression.

Families should pay special attention to elderly male relatives who are alone, because they are at especially high risk for suicide. In addition to finding psychiatric help for them, family members should remove anything from their homes (such as knives) that they could use to harm themselves.

Call your health care provider if you feel worthless or hopeless, or if you cry often. Also call if you are having trouble coping with stresses in your life and want to be referred for counseling.

Go to the nearest emergency room or call your local emergency number (such as 911) if you are thinking about suicide (taking your own life).

If you are caring for an aging family member and think they might have depression, contact their health care provider. Often, older patients will not admit to the signs and symptoms of depression out of pride.

Preventing depression depends on the factors involved. Social supports that help people deal with loss, mobility changes, and other depression triggers can be helpful. In many cases, there is no way to prevent depression.

Screening for Depression Recommendations and Rationale. US Preventive Services Task Force, Guidelines from Guide to Clinical Preventive Services: 3rd ed. Rockville, Md. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; May 1, 2002.

Guide to Clinical Preventive Services: Screening for Depression, Recommendations and Rationale. Rockville, Md. US Preventive Services Task Force, Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. Ann Intern Med. 2002; 136(10): 760–764.

Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd ed. Arlington, VA: American Psychiatric Association; 2000.