Depression and ageing

We all feel sad, moody or low from time to time. For some people, though, these feelings are intense, last for a long time (weeks, months or even years) and sometimes arise for no obvious reason. Depression is more than a low mood. It is a serious condition that affects both physical and mental health.

About one in six women and one in eight men will experience depression at some stage of their lives. The exact rates in older people are not known, but it is thought that between 10 and 15 per cent of people over the age of 65 experience depression. Rates among people living in residential aged care are believed to be much higher, at around 30 per cent.

Depression is often not recognised in older people. Symptoms such as sadness, sleep and appetite problems or mood changes may be dismissed as a “normal” part of getting older. Poor concentration and memory difficulties may also be confused with other conditions, such as dementia.

Older people are at greater risk of mental health conditions because of the combined effect of several factors, including chronic illness and isolation. However, there is no evidence that ageing itself is a risk factor for depression. Depression can reduce a person’s quality of life and strain their relationships with family and friends.

Severe depression is a risk factor for suicidal thoughts, and suicide risk can be high among the oldest age groups. If you or someone you know is having thoughts of suicide or self-harm, seek help straight away from a doctor, a crisis line or emergency services.

Depression among older people can be easily missed#

Older people may find it hard to recognise or talk about feeling sad or depressed, and may not reach out for help. Symptoms that would raise concern in a younger person, such as insomnia or social withdrawal, may be brushed aside as “just getting older”. Depression can also affect memory and concentration, and these changes are sometimes wrongly put down to ageing rather than depression.

For these reasons, it is important to think proactively about depression and to consider whether it may be present.

How depression affects a person#

Depression affects how people think, feel and act. A person may:

• Lose interest in things they normally enjoy
• Lack energy
• Have difficulty sleeping or sleep more than usual
• Feel irritable
• Find it hard to concentrate

Depression makes everyday life harder to manage. An older person may be experiencing depression if, for more than two weeks, they have had several signs and symptoms across the categories below.

• Feelings may include sadness, hopelessness, emptiness, feeling overwhelmed, worthlessness, guilt, indecisiveness and loss of self-esteem.
• Thoughts may include suicidal thoughts, frequent thoughts of death, and negative comments such as “I’m a failure” or “Life is not worth living”.
• Behaviour may include withdrawing from family and friends, neglecting responsibilities and self-care, behaving out of character, and denial of depressive feelings as a defence mechanism.
• Physical symptoms may include significant weight or appetite change, sleeping more or less than usual, constant tiredness, slowed movement or restlessness, unexplained aches and pains, and digestive upsets.

Everyone has some of these symptoms from time to time, and they do not always mean a person is depressed. Equally, not everyone with depression will have all of them. Older people may also use different language to describe how they feel. Instead of “sadness”, for example, they may talk about “their nerves”.

What causes depression#

The exact cause of depression is not known. It usually does not come from a single event, but from a combination of biological vulnerability, personality, life experiences and recent events, particularly those involving loss.

Factors that may be linked with depression include:

• Personality factors, such as being self-critical, negative, a worrier or a perfectionist
• Drug or alcohol use
• An increase in physical health problems or conditions such as heart disease, dementia or cancer
• A significant change in living arrangements, such as moving from independent living into a care setting
• Particular anniversaries and the memories they bring
• Loss of independence, chronic pain, side effects of medication, and social isolation or loneliness

In older people, physical illness and personal loss are common triggers.

Treatment for depression#

Depression is unlikely to simply go away on its own. Left untreated, it can continue for months or years and have many negative effects on a person’s life. The good news is that a range of treatments, health professionals and services can help, and there are many things people can do to support themselves. Different types of depression call for different types of treatment.

Psychological treatments#

Several psychological therapies are effective for depression in older people. These include cognitive behaviour therapy (CBT), interpersonal therapy (IPT) and reminiscence therapy.

CBT helps people identify and change negative patterns of thinking and improve their coping skills, so they are better able to deal with life’s stresses and conflicts. Psychological therapies can support recovery and may also help prevent depression from returning. They can be delivered one-on-one, in groups or online.

Medical treatments#

If you are experiencing moderate to severe depression, your doctor may prescribe antidepressant medication alongside psychological treatment. Antidepressants are sometimes used when other treatments have not worked, or when psychological treatment is not possible because of the severity of the condition or a lack of access to it.

Electroconvulsive therapy (ECT) is sometimes recommended for people with severe, life-threatening depression that has not responded to psychological therapy or medication. ECT can only be provided by psychiatrists in specialist facilities.

Key points#

• Symptoms such as poor concentration and memory difficulties may also be confused with other conditions such as dementia.
• There is no evidence that ageing itself is a risk factor for depression later in life.
• Severe depression is a risk factor for suicidal thoughts.
• It is important to think proactively about the possibility of depression and assess whether it may be present.
• Behavioural symptoms can include denial of depressive feelings as a defence mechanism.

Where to get help#