Confronting Sadness in Seniors

By Matthew Shulman

A bit of sadness is a common companion of aging. Over time, after all, seniors may lose vigor, independence, and even loved ones. But when melancholy becomes outright depression, the elderly are at risk of diabetes, heart disease, and even suicide. It's often up to their unofficial caretakers—their children—to spot depression's signs and take steps to address it.

Depression often manifests differently in the elderly than in younger people. Rather than expressing feelings of sadness, depressed seniors may describe physical complaints—increased aches and pains, headaches, weakness, and, commonly, trouble sleeping. "Look for changes in levels of interest, too," says Dan Blazer, professor of psychiatry and behavioral sciences at Duke University Medical Center. Increases in anxiety, irritability, withdrawal, and a decrease in attention to appearance are also common signs. Sometimes, depression arises because of a physical health problem, says Gary Moak, president of the American Association for Geriatric Psychiatry and a professor at the University of Massachusetts Medical School. For example, he says, "as many as 40 percent of stroke victims will develop depression, because many [strokes] occur in an area of the brain that's closely related to the processing and management of emotions." Overall, about 1 in 5 people age 65 and older has depression, according to Moak. The vast majority don't receive the professional treatment they need.

Untreated depression can lead to needless pain and distress. For one thing, seniors commit 20 percent of all suicides, while representing only 13 percent of the population. Depression also "amplifies" common age-related diseases such as heart disease and diabetes, says Charles Reynolds, a professor of geriatric psychiatry at the University of Pittsburgh Medical Center. It can also weaken immunity and worsen arthritis and Parkinson's disease.

Solutions for late-life depression run the gamut from medication to talk therapy to closer engagement with friends and family. All should be considered, experts say. Reynolds's research shows that long-term antidepressant use can reduce the recurrence of depressive episodes by 60 percent over two years. In the most severe cases, a combination of medication and psychotherapy is more effective than either alone, says Elise Beaulieu, a geriatric social worker with Boston University.

Social support from family and friends is among the keys to recovery. For seniors who are isolated, forming new networks outside the family—through a senior center, say, or a volunteer job—can have a positive influence. For Randal Perkins, that meant moving his 69-year-old mother from Florida, where she'd developed depression, to Pittsburgh so she could live with family. She now receives medication and psychotherapy, and Perkins also takes a personal role in sustaining her mood. Taking her to church functions, to visit family, and to the local library can "lift her spirits," he says. "She smiles more, interacts more with people, has more conversation, and in the end will tell you, 'I'm glad I made the effort.' "