Depression and aging: Recognize the signs so you can get help

The first signs of depression hit when David M. was almost 60. He was consumed by thoughts of failure at a job he didn’t like, and scared of the friction in his failing marriage. He was overwhelmed with feelings of helplessness, anger and self-loathing. David was also exhausted – there were times when he couldn’t even muster the energy to sign his own name. “I was just feeling out of control,” says the 67-year-old Florida resident. “It’s the worst feeling I’ve ever had, including medical illnesses or physical injuries.”

Depression is often associated with teenagers or people nearing middle age. But it can have a devastating impact on seniors. Just ask one of the 6.5 million Americans 65 or older who are affected by the disorder. Without seeking help, the darkness of depression can invade every part of your life, making your senior years anything but golden.

Common causes of depression in seniors

For most people, depression is triggered by more than one factor. “Some have a vulnerability based on their genetics and the circuitry in their brains. Others have psychological vulnerability from the way they were treated growing up,” says Simon A. Rego, a chief psychologist at Montefiore Medical Center/Albert Einstein College of Medicine in New York City and former board member of the Anxiety and Depression Association of America.

Gender can also play a role. According to Dr. Gabriela Cora, a board-certified psychiatrist and medical director of Aetna Behavioral Health, women are more likely to develop depression than men. This could be linked to genetic and hormonal differences in addition to environmental factors.

These factors can be made worse by life experiences common to seniors, such as the loss of a partner or friends, transitioning into retirement and chronic health conditions. A series of devastating events caused a downward spiral for Janet G., a 67-year-old New Jersey resident. After her husband was laid off and she was diagnosed with a precancerous condition, Janet grappled with persistent insomnia and feelings of despair. “I had no energy to socialize,” she says. “I cried a lot alone in the basement.” Janet couldn’t acknowledge she had depression, even though she had a family history of the disorder. “I kept waiting for the feelings to go away,” she says.

Social isolation is another common trigger for depression in seniors. Studies show there is a “loneliness epidemic” among older Americans that’s been attributed to everything from a decline in attending church and other organized activities to an increase in time spent online instead of socializing. Even relocating to a new neighborhood or town after retirement can make you feel lonely. “It’s not uncommon for people to move to a cheaper place when retiring and suddenly they don’t have family or friends near them,” Dr. Cora explains.

What depression looks like in older adults

Depression can look different in seniors, and symptoms are often mistaken for a natural part of aging. Experts recommend seeking help if you have three or more of the following symptoms that last for more than two weeks and interfere with daily living:

• Memory problems and confusion
• Social withdrawal
• Loss of pleasure
• Loss of appetite or weight loss
• Vague complaints of pain
• Inability to sleep
• Irritability
• Demanding behavior
• Change in personality
• Delusions or hallucinations
• Thoughts of self harm

The importance of seeking help

A crucial first step is to speak to someone you trust, like your primary doctor, Dr. Cora says. He or she may want to examine you, since certain medical conditions like hypothyroidism, stroke and Parkinson’s disease can mimic signs of depression. Learn how depression and anxiety share some symptoms. Your doctor can also refer you to a licensed mental health counselor. If you prefer not to meet in person, there’s virtual assistance, where a counselor helps you via phone or video. If you’re an Aetna member, you can use the AbleTo support program to arrange phone calls or face-to-face videoconferencing with specialists who can help you address emotional challenges and develop an action plan in the course of eight weeks.

Whether you meet in person or online, the first line of treatment for depression is typically psychotherapy, or “talk therapy.” Your therapist can also decide whether medication is right for you. Remember, depression is nothing to be ashamed of. It is highly treatable so it’s important to take that first step and ask for help.

Strategies to help keep depression in check

Making lifestyle changes as you age is also important to preventing or managing depression, says Dr. Cora, who tells older adults to pay attention to the “four pillars” of good health: nutrition, exercise, relaxation and sleep habits. Some helpful tips:

• Relaxation during the day helps nighttime sleep, so try meditation, prayer, guided imagery and even dancing.
• “Get up, get dressed and out – even 30 minutes of walking around the block,” says Gary J. Kennedy, MD, director of the Division of Geriatric Psychiatry and Fellowship Program at Albert Einstein College of Medicine in New York. Vigorous exercise helps build new neurons in the brain. Get expert tips on how to kickstart a new fitness plan. If you’re immobile, consider a chair yoga class or water aerobics or ask your physical therapist to develop an exercise plan, Dr. Kennedy suggests.
• Replace screen time with face time. Join a choir, take a class, or make a date with a loved one.
• Support groups may be helpful for people who are disabled or homebound. Community or church groups can come to you and provide social connection.
• Prepare for major life changes, like retirement, by planning how you are going to spend your time.
• Stay in touch with family and let them know when you feel sad.

Though she was ultimately hospitalized for major depression, today Janet is home and active again. She continues therapy and medication, and despite two knee replacements and the dissolution of her son’s marriage, she has had no relapses. David is seeing similar success: After medication, psychotherapy, guided meditation and a weekly tennis game, he’s feeling optimistic once again. “Getting out of the house and around other people and talking and laughing are my go-to prescriptions for depression,” he says. “I try to be grateful for every day now.”