Stress can lead to depression. While many aging Americans look forward to a happy and healthy retirement, many seniors face a disproportionate amount of stressors. Losing loved ones, feeling useless and unproductive after years on the job, loss or decline in physical senses, chronic illness, and the financial pressure of mounting medical bills can, and often do, lead to depression among seniors even if there has been no prior history of mental illenss. Says Kathleen Buckwalter, PhD, RN, professor of gerontological nursing with the University of Iowa,
Aging experts agree it is important that adult children and other family members learn to tell the difference between the signs and symptoms of senior depression from ordinary feelings of melancholy.
Signs of senior depression
According to Joel E. Streim, MD, a professor of geriatric psychiatry with the University of Pennsylvania, "If your parent is not eating for more than a few days, or loses interest in activities that used to give him or her pleasure for longer than two weeks, it could be depression." Other signs of depression include:
- Feelings of persistent sadness, anxiety or feeling "empty"
- Pessimistic feelings, hopelessness
- Low self-esteem, persistent guilt or feelings of worthlessness
- High irritability, restlessness, aggressive behavior
- Chronic fatigue and lack of energy
- Memory loss, difficulty concentrating, indecisiveness
- Disruption of sleep patterns
- Suicidal thinking, suicide attempts
- Pains, cramps, headaches with unknown cause that do not cease even with treatment
Looking at the above list you can see that many of these may also just be signs of aging – so it becomes particularly difficult to spot early signs of depression in the elderly. Dr. Streim also reminds us that depressed seniors do not always look depressed or express depression the same way younger folks do. Says Streim, an elderly parent may not tell you outright they are “sad” or “feeling lonely” because they are afraid of being a burden on the family, but “they may show signs of distress by wringing their hands excessively, getting agitated or irritable, or having difficulty sitting still."
Dr. Streim also points out that it is important that adult children dealing with a depressed parent recognize that depression is an illness, not laziness. Adult children should be aware of the disability that depression can cause and should avoid making depressed parents feel worse by telling them to “just get over it” or to “pull themselves up by the bootstraps.”
Treatment for depression
The most commonly used treatments for depression in the elderly are psychotherapy and antidepressant medication, or a combination of both methodologies. Prescribing antidepressants for seniors with depressions can be a little tricky because of changes in the way the aging body metabolizes drugs, and the interactions with other medications they may be taking. Therefore, an aging parent with mild or moderate depression may benefit from talk therapy and should be encouraged to try that first. For severe or incapacitating depression, medication is generally recommended in addition to psychotherapy. However, make sure that you and the treating physicians are all well aware of any medications that have been prescribed for your parent, and monitor the dosages carefully. Often due to confidentiality restrictions, a psychiatrist may not be required to share prescription information with family members unless the patient has given permission, so make sure your loved one has done so.