Depression in seniors

Depression is sometimes viewed as a normal part of aging.

It shouldn't be. Left untreated, depression increases the likelihood of disability, placement in a nursing home, and death. Suicide risk also increases with age; white men over age 85 have the highest suicide rate in the United States. Depression in the elderly can often be treated effectively, but when depressive symptoms arise, it can be challenging not to mistake them for symptoms of another medical disorder, reports the February 2008 issue of the Harvard Mental Health Letter.

Although some elderly people with depression develop classic symptoms such as persistent sadness and despair, others may seek help for less typical symptoms such as heart palpitations, fatigue, tremors, or vomiting. People may also report cognitive problems such as an inability to concentrate or remember things.

It's not entirely clear why symptoms of depression in the elderly may differ from those in younger adults. Coexisting medical problems, medication side effects, and the natural aging process may all contribute.

Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter, notes that it's important for doctors who suspect depression in an elderly patient to assess the person's physical health problems and medications to determine whether these might be contributing to depressive symptoms. In some people, treating an underlying medical problem will alleviate depression, but other patients will require antidepressant medications (starting at half the dose used in younger adults), psychotherapy, or both. While it may take some time to determine the best treatment strategy for a particular individual, the reward is often a better quality of life.

Also in this issue:

• Measuring empathy during psychotherapy
• Medication updates about tamoxifen, antidepressants, and long-acting antipsychotics
• Exercise, estrogen, and thinking
• Unmet mental health needs worldwide
• Cognitive behavioral therapy for depressed adolescents
• Political preferences and the brain

The Harvard Mental Health Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $59 per year. Subscribe at www.health.harvard.edu/mental or by calling 877-649-9457 (toll-free).