Depression, one of the most common conditions
associated with suicide in older adults,1 is a widely underrecognized and
undertreated medical illness. In fact, several studies have found that many
older adults who die by suicide—up to 75 percent—have visited a primary care
physician within a month of their suicide.2 These findings point to the urgency
of improving detection and treatment of depression as a means of reducing
suicide risk among older persons.
Older Americans are disproportionately likely to die by suicide. Comprising only
13 percent of the U.S. population, individuals age 65 and older accounted for 18
percent of all suicide deaths in 2000. Among the highest rates (when categorized
by gender and race) were white men age 85 and older: 59 deaths per 100,000
persons in 2000, more than five times the national U.S. rate of 10.6 per
100,000.3
Of the nearly 35 million Americans age 65 and older, an estimated 2 million have
a depressive illness (major depressive disorder, dysthymic disorder, or bipolar
disorder) and another 5 million may have “subsyndromal depression,” or
depressive symptoms that fall short of meeting full diagnostic criteria for a
disorder.4,5 Subsyndromal depression is especially common among older persons
and is associated with an increased risk of developing major depression.6 In any
of these forms, however, depressive symptoms are not a normal part of aging. In
contrast to the normal emotional experiences of sadness, grief, loss, or passing
mood states, they tend to be persistent and to interfere significantly with an
individual's ability to function.
Depression often co-occurs with other serious illnesses such as heart disease,
stroke, diabetes, cancer, and Parkinson’s disease.7 Because many older adults
face these illnesses as well as various social and economic difficulties, health
care professionals may mistakenly conclude that depression is a normal
consequence of these problems—an attitude often shared by patients themselves.8
These factors together contribute to the underdiagnosis and undertreatment of
depressive disorders in older people. Depression can and should be treated when
it co-occurs with other illnesses, for untreated depression can delay recovery
from or worsen the outcome of these other illnesses. The relationship between
depression and other illness processes in older adults is a focus of ongoing
research.
Both doctors and patients may have difficulty identifying the signs of
depression. NIMH-funded researchers are currently investigating the
effectiveness of a depression education intervention delivered in primary care
clinics for improving recognition and treatment of depression and suicidal
symptoms in elderly patients.9
Research and Treatment
Research has revealed varying patterns of clinical and biological features among
older adults with depression.8 As compared to older persons whose depression
began earlier in life, those whose depression first appears in late life are
likely to have a more chronic course of illness. In addition, there is growing
evidence that depression beginning in late life is associated with vascular
changes in the brain.
Both antidepressant medications and short-term psychotherapies are effective
treatments for late-life depression.8 Existing antidepressants are known to
influence the functioning of certain neurotransmitters in the brain. The newer
medications, chiefly the selective serotonin reuptake inhibitors (SSRIs), are
generally preferred over the older medications, including tricyclic
antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), because they
have fewer and less severe potential side effects.10 Both generations of
medications are effective in relieving depression, although some people will
respond to one type of drug, but not another.
Research has shown that certain types of short-term psychotherapy, particularly
cognitive-behavioral therapy and interpersonal therapy, are effective treatments
for late-life depression.8 In addition, psychotherapy alone has been shown to
prolong periods of good health free from depression. Combining psychotherapy
with antidepressant medication, however, appears to provide maximum benefit. In
one study, approximately 80 percent of older adults with depression recovered
with combination treatment.11 The combination treatment was also found to be
more effective than either treatment alone in reducing recurrences of
depression.12
More studies are in progress on the efficacy and longer-term effectiveness of
SSRIs and specific psychotherapies for depression in older persons. Findings
from these studies will provide important data regarding the clinical course and
treatment of late-life depression. Further research will be needed to determine
the role of hormonal factors in the development of depression in older adults,
and to find out whether hormone replacement therapy with estrogens or androgens
is of benefit in the treatment of late-life depression.
Older Adults...
Before you say,
"I'm fine"...
Ask yourself if you feel:
nervous or "empty"
guilty or worthless
very tired and slowed down
you don't enjoy things the way you used to
restless and irritable
like no one loves you
like life is not worth living
Or if you are:
sleeping more or less than usual
eating more or less than usual
having persistent headaches, stomach aches, or chronic pain
These may be syptoms of Depression,
a treatable medical illness.
But your doctor can only treat you if
you say how you are really feeling.
Depression is not a normal part of aging.
Talk to your doctor
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For More Information
Please visit the following links for more information about organizations that
focus on depression and older adults.
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All material in this fact sheet is in the public domain and may be copied or
reproduced without permission from the NIMH. Citation of NIMH as the source is
appreciated.
NIH Publication No. 03-4593
Printed January 2001
Revised May 2003
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References
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International Psychogeriatrics, 1995; 7(2): 149-64.
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3Office of Statistics and Programming, NCIPC, CDC. Web-based Injury Statistics
Query and Reporting System (WISQARSTM): http://www.cdc.gov/ncipc/wisqars/default.htm.
4Narrow WE. One-year prevalence of depressive disorders among adults 18 and over
in the U.S.: NIMH ECA prospective data. Unpublished table.
5Alexopoulos GS. Mood disorders. In: Sadock BJ, Sadock VA, eds. Comprehensive
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2000.
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diagnosis. Clinical practice guideline, number 5. AHCPR Publication No. 93-0550.
Rockville, MD: Agency for Health Care, Policy and Research, 1993.
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ML, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, Parmelee
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10Reynolds CF 3rd, Lebowitz BD. What are the best treatments for depression in
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11Little JT, Reynolds CF 3rd, Dew MA, Frank E, Begley AE, Miller MD, Cornes C,
Mazumdar S, Perel JM, Kupfer DJ. How common is resistance to treatment in
recurrent, nonpsychotic geriatric depression? American Journal of Psychiatry,
1998; 155(8): 1035-8.
12Reynolds CF 3rd, Frank E, Perel JM, Imber SD, Cornes C, Miller MD, Mazumdar S,
Houck PR, Dew MA, Stack JA, Pollock BG, Kupfer DJ. Nortriptyline and
interpersonal psychotherapy as maintenance therapies for recurrent major
depression: a randomized controlled trial in patients older than 59 years.
Journal of the American Medical Association, 1999; 281(1): 39-45.
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