Overview, Causes, & Risk Factors
Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings don't go away on their own. They are not necessarily related to a particular life event.
What is going on in the body?
Depression is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved in depression. Nerve impulses cause the release of neurotransmitters from one nerve cell, or neuron, to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression. Some of the neurotransmitters believed to be linked to depression are serotonin, norepinephrine, and dopamine.
The elderly face a lot of situations that can contribute to depression. Many important social support systems are lost. This may be due to the death of a spouse or close friend, retirement, or moving to a new home. The elderly are often also dealing with chronic illnesses. The illnesses can decrease activity, which also leads to depression.
What are the causes and risks of the condition?
There are many theories about what causes depression. Depression may be caused by any of these things:
certain medicines, including antibiotics
changes in brain chemicals
lack of sunlight
negative thinking patterns
Risk factors for depression in adults include:
drug abuse and addiction
personal history of a suicide attempt
personal or family history of depression
Older individuals may face additional risk factors because of the aging process or chronic disease. These factors include:
aging changes in the senses
age-related hearing loss
concern about living arrangements
coronary artery disease
death of a spouse or other loved one
some medicines and drug interactions
In the U.S., depression affects 3% to 5% of people over age 65. When the person has a medical illness, such as coronary artery disease, the rate increases to 40%.
Symptoms & Signs
What are the signs and symptoms of the condition?
Some symptoms are common in people of all ages with depression. These symptoms include:
difficulty paying attention or making decisions
feeling very sensitive emotionally
feelings of irritability
feelings of sadness, despair, and emptiness
inability to feel pleasure
loss of motivation and withdrawal from others
thoughts about suicide and death
Seniors who are depressed may avoid family and friends. They may also show signs of confusion.
Diagnosis & Tests
How is the condition diagnosed?
Screening tests for depression include:
the Beck Depression Inventory (BDI) 19
the Center for Epidemiologic Studies Depression (CES-D) Scale
A person who screens positively on one of these tests should have a comprehensive evaluation for depression. The evaluation may include a medical history, physical examination, and laboratory tests.
Depression is underdiagnosed in the elderly. The signs of depression may not be as clear as they are in a younger person. Elderly people may tell their healthcare provider about aches and pains or other mood states such as agitation. Symptoms may be confused with other ailments, such as Alzheimer's disease. Seniors may not be aware that they are depressed. They may think they are too old to get help. Some seniors believe that seeking help is a sign of weakness.
Prevention & Expectations
What can be done to prevent the condition?
Depression may not be preventable. However, these steps may be helpful in preventing it:
avoiding alcohol and illegal drugs
avoiding cigarette smoking
getting prompt treatment for other psychiatric disorders
seeking effective treatment for chronic diseases
talking with a counselor after experiencing a major trauma
Depression can lead to suicide. It is important to recognize and treat the condition early. Individuals should be encouraged to talk to someone if they are concerned about depression. There are many people to whom
they can talk, including:
a clergy member
a counselor at a senior center
a family doctor
a professional at a mental health center
a trusted family member
What are the long-term effects of the condition?
With good treatment, many people recover from depression. Some people experience it only once in their lives. Others have periodic bouts of depression.
If depression is not effectively treated, a person can experience serious difficulties in every area of life. Depression often hurts relationships. It also impairs work and volunteer participation. In some cases, it leads to suicide.
People with depression are at higher risk for many chronic diseases and conditions, including:
coronary artery disease
Seniors who are depressed are more likely to report poor health status and low quality of life. They are also more likely to die from health problems, such as heart attack.
What are the risks to others?
Depression is not contagious.
Treatment & Monitoring
What are the treatments for the condition?
The two most common ways of treating depression are with antidepressant medicines and psychotherapy. Often a combination is used. Occasionally, a person must be hospitalized for intense treatment or for his or her own safety.
Antidepressant medicines are effective in:
increasing the person's ability to function in daily life
lowering the risk of suicide
making the person feel better
The following types of medicines are used to treat depression:
monoamine oxidase inhibitors (MAOIs), such as phenelzine sulfate and tranylcypromine sulfate
other antidepressants, such as nefazodone and venlafaxine
selective serotonin reuptake inhibitors (SSRIs), including paroxetine HCl and fluoxetine HCl
tetracyclic antidepressants, such as maprotiline HCl and mirtazapine
tricyclic antidepressants (TCAs), including amitripyline HCl and desipramine HCl
Psychotherapy can help people:
cope better with having depression
feel less alone
improve relations with family, friends, and coworkers
learn about depression and how it affects them
learn to recognize and avoid situations that can bring on a depressive episode
learn to view the world and others more positively and more realistically
positively address problems that they may be facing
stop episodes of depression early by recognizing warning signs and symptoms
What are the side effects of the treatments?
Antidepressants may cause mild and usually temporary side effects in some people. The most common side effects are:
What happens after treatment for the condition?
An individual can help prevent relapses by living a healthy lifestyle. Some important parts of the healthy lifestyle include:
avoiding alcohol, illegal drugs, and smoking
doing regular exercise
eating a balanced diet, following the food guide pyramid
finding a support system for dealing with depression
finding ways to manage stress
getting enough rest
How is the condition monitored?
Once a person has an episode of depression, he or she is at higher risk for further episodes. Any new or worsening symptoms should be reported to the healthcare provider. The provider may recommend regular visits to monitor symptoms. The provider may also order blood tests to monitor the levels of medicines.