Why It May Be More Than "The Blues"

By Jane Farrell

Everyone feels blue now and then. It’s part of life. But if you no longer enjoy activities that you usually like, there may be a more serious problem. Feeling depressed without letup can change the way you think and the way you experience emotions. Doctors call this clinical depression.

It’s important to remember that being “down in the dumps” over a period of time isn’t a normal part of getting older. But it is a common problem, and medical help may be needed. For most people, depression gets better with treatment. Counseling (talk therapy), medicine, or other treatments can ease the pain of depression.

There are many reasons why depression in older people is often missed or untreated. As a person ages, the signs of depression vary more than those of a younger person. Sometimes older people who are depressed appear to feel tired, have trouble sleeping, or seem grumpy and irritable. Confusion or attention problems caused by depression can sometimes look like Alzheimer’s disease or other brain disorders. Mood changes and signs of depression can be caused by medicines older people may take for arthritis, high blood pressure, or heart disease. But the good news is that people who are depressed usually feel better with the right treatment.

What Causes Depression?

There is no one cause of depression. For some people, a single event can bring on the illness. Depression often strikes people who felt fine but who suddenly find they are dealing with a death in the family. For some people, changes in the brain can affect mood and cause depression. Sometimes, those under a lot of stress, like caregivers, can feel depressed. People may be diagnosed with a life-changing health problem such as cancer, diabetes and heart disease. Others become depressed for no clear reason.

Genetics, too, can play a role. Studies show that depression may run in families. Children of depressed parents may be at a higher risk for depression. Also, depression tends to be a disorder that occurs more than once. Many older people who have been depressed in the past will be at an increased risk for becoming depressed again.

What to Look For

How do you know when you or a loved one need help? Without help, depression can last for weeks, months, or even years. If you or a loved one have several of the following signs of depression and they last for more than two weeks, see a doctor.

An “empty” feeling, ongoing sadness, and anxiety

Tiredness, lack of energy

Loss of interest or pleasure in everyday activities, including sex

Sleep problems, including trouble getting to sleep, very early morning waking, and sleeping too much

Eating more or less than usual

Crying too often or too much

Aches and pains that don’t go away when treated

A hard time focusing, remembering, or making decisions

Feeling guilty, helpless, worthless, or hopeless

Being irritable

Thoughts of death or suicide

If you are a family member, friend, or healthcare provider of an older person, watch for clues. Sometimes depression can hide behind a smiling face. A depressed person who lives alone may appear to feel better when someone stops by to say hello. The symptoms may seem to go away. But when someone is very depressed, the symptoms usually come back.

Don’t ignore the warning signs. If left untreated, serious depression may lead to suicide. Listen carefully if someone of any age complains about being depressed or says people don’t care. That person may really be asking for help. If you or a loved one are thinking about suicide, reach out. Call your doctor or call 911 to get help. Don’t hesitate to go to an emergency room. You might also ask a friend or family member to help.

There’s also a toll-free, 24-hour National Suicide Prevention Lifeline: 1-800-273-TALK (1-800-273-8255), and 1-800-799-4TTY (1-800-799-4889)

But even if you or a loved one aren’t experiencing an immediate crisis, the first step is to accept that help is needed. Sometimes that’s easier said than done. You may not be comfortable with the subject of mental illness. Or you might feel that asking for help is a sign of weakness, or that you should be able to “snap out of it.” That won’t happen.  

Once you or your loved one decide to get medical advice, start with the family doctor. Your doctor should check to see if the depression could be caused by a health problem (such as hypothyroidism or vitamin B12 deficiency) or is a side effect of medicine you’re taking. After a complete exam, your doctor may suggest you talk to a social worker, counselor, psychologist, or psychiatrist.

Be aware, though, that some family doctors may not understand about aging and depression. If your doctor is unable or unwilling to help, you may want to talk to another healthcare provider.

Don’t avoid getting help because you’re afraid of how much treatments might cost. Often, only short-term counseling is needed. Treatment for depression is usually covered by private insurance and Medicare. Also, some community mental health centers may offer treatment based on a person’s ability to pay.

Do you have a friend or relative who won’t go to a doctor for treatment? Try explaining how treatment may help the person feel better. In some cases, when a depressed person can’t or won’t go to the doctor’s office, the doctor or mental health specialist can start by making a phone call. A phone call can’t take the place of the personal contact needed for a complete medical checkup, but it might motivate the person to go for treatment.

Treating Depression

Different therapies seem to work for different people. For instance, support groups can provide new coping skills or social support during or after a major life change. Several kinds of talk therapies are useful as well. One method might help you think in a more positive way. Always focusing on the sad things in your life or what you have lost might contribute to depression. Another method works to improve your relations with others so you will have more hope about your future.

Antidepressant drugs can also help. These medications can improve your mood, sleep, appetite, and concentration. Some of these medicines are effective in a few weeks while you may need to take others for 2 or 3 months before you begin to feel better. Be sure to take your medicine the way it was prescribed for you. Your doctor may want you to continue medications for 6 months or more after your symptoms disappear.

Some antidepressants can cause unwanted side effects, although newer medicines have fewer side effects. Any antidepressant should be used with great care to avoid this problem. Remember:

The doctor needs to know about all prescribed and over-the-counter medica­tions, vitamins, or herbal supplements you are taking.

The doctor should also be aware of any other physical problems you have.

Be sure to take antidepressants in the proper dose and on the right schedule.

If you are still very depressed after trying therapy and/or medication, your doctor can help you choose other treatment options that may work for you.

Help From Family and Friends

Family and friends can play an important role in treatment. They can encourage someone who is depressed to stay with the treatment plan. Or, they may make appointments or accompany their friend or relative to see the doctor or go to a support group.

Be patient and understanding. Ask your relative or friend to go on outings with you or to go back to an activity that he or she once enjoyed. Encourage the person to be busy but not to take on too much at one time.

Preventing Depression

What can be done to lower the risk of depression? How can people cope? There are a few steps you can take. Try to prepare for major changes in life, such as retirement or moving from your home of many years. Stay in touch with family. Let them know when you feel sad. Friends can help ease loneliness if you lose a spouse. Consider new hobbies that help keep your mind and body active. If you are faced with a lot to do, try to break the task into smaller jobs that are easy to finish.

Regular exercise may also help prevent depression or lift your mood if you are somewhat depressed. Older people who are depressed can gain mental as well as physical benefits from mild forms of exercise like walking outdoors or in shopping malls. Gardening, dancing, and swimming are other good forms of exercise. Pick something you like to do. Begin with 10–15 minutes a day, and increase the time as you are able. Being physically fit and eating a balanced diet may also help avoid illnesses that can bring on disability or depression.

Remember, with treatment, most people will begin to feel better. It takes time, but it can happen.

Reprinted with permission from the National Institute On Aging.