Last Updated on 14 September 2022 by Ray Plumlee
Geriatric depression or depression in the elderly is accompanied by changes in the emotional and mental state of a person. Older adults more often get a feeling of sadness, but this doesn’t mean that depression is a part of aging. Many older adults seem to have a perfectly normal life without any mental agility or issues.
Depression in the elderly may be called as subsyndromal depression. This is because it doesn’t completely correlate with the major depression. But if it is left unattended, the symptoms may get bad enough to cause major depression. Depression, be it any type, affect life’s quality and cause the risk of suicide.
So, what does it look like?
The results may vary, but the percentage of depression in the elderly is as follows:
About 1% to 5% of older adults become a victim of the depression in a community in which it is about 12% in hospitalized patients and 14% in people living at home. Some studies suggest that in nursing homes, depression affects about 29% to 52% of those people. Speaking of which, 39% to 47% of such people are those who have been treated for cancer, heart attack, or stroke.
Causes of Geriatric Depression:
Depression is the combined effect of various factors. The disease often has a genetic link, according to some research. But in the elderly, the biological, social, and psychological factors all can lead to depression.
The following points may be the reason for depression:
- The decreased level of neurotransmitters in the brain, like serotonin and norepinephrine.
- Depression already prevailing in the family.
- Trauma such as abuse or the death of a beloved.
The other factors that become common with aging and have a role in depression are the following:
- Encountering mortality
- Retirement after a long age of work
- Financial problems
- Continuous substance abuse
- Death of any beloved person
- Widowhood or divorce
- Chronic medical conditions
Symptoms and Medical Conditions Linked with Geriatric Depression:
Although many older people experience the same classic symptoms like sadness and despair during the depression, others may also get typical symptoms that suggest the onset of any other medical condition initially rather than the depression. Patients may get somatic symptoms like:
- Heart palpitations
- Body aches and pains
- Nausea or vomiting
- Shortness of breath
- Heavy perspiration
- Facial flushing
Cognitive problems like:
- Inability to concentrate
- Failure at remembering things
Mood disturbance that can lead to:
- Death anxiety
Why are the symptoms of depression in the elderly different for that in younger adults? The question is yet to be answered entirely. Any medical problem, medication side effects, the aging process, emotional issues, and social stigma; all can equally contribute to the depression.
So, to fully diagnose depression in the elderly, the clinician needs to assess the health-related problem in the individuals and medications they are using. Because sometimes, these issues are what causing the depressive symptoms.
If this is the case, then treating these medical ailments will help to alleviate the depression. Otherwise, some people need drugs or even psychotherapy to overcome mood disorders. The following medical problems may be the underlying cause of depression in the elderly.
Any vascular disease influences depression in the people. Like, depression hits 25% of those people who have a heart attack or earlier when they are going for cardiac catheterization. 20% of the people having a stroke get a major depression afterward. One study concluded that death rates were likely to be four times higher in the depressive older than those people without depression.
The vascular depression hypothesis suggests that when blood vessel pathology alters, it will lead to less communication within the brain that may trigger depression. The vascular depression causes cognitive impairment in the elderly, and they would soon feel gloomy, apathetic, agitated, or guilty.
Psychosis associated with depression is frequent in about 3.6% of the elderly people living in a community and 20% to 45% of the hospitalized older. Delusion causes both physical and mental symptoms such as persecutory effect, guilt, or nihilism, all of which together suggesting the presence of psychosis and depression.
Dementia is a part of many mental diseases like Alzheimer’s. It is about 17% that people with Alzheimer’s disease end up having major depression, and the ratio is even more in other types of dementia. Both dementia and depression are interconnected with each other. The presence of one condition may lead to the development of the other. If depression and cognitive impairment occur at the same time, the complication may be worsened and cause the occurrence of pseudodementia; a problem often gets confused with dementia. Cognitive impairment can be treated with depression, but some people would remain mentally unfit that may aggravate with time.
If the elderly people have hypothyroidism or vitamin B deficiency, chances are they may get cognitive impairment and exhaustion that give a clue about the prevailing depression. Early diagnosis and treatment of these problems help in alleviating the symptoms.
Many drugs like beta-blockers (for high blood pressure) and benzodiazepines (tranquilizers) in the elderly show side effects like depressive symptoms. Reducing the dose of such drugs or replacing them with a new medication would be helpful in this case.
Treatment Strategy for Geriatric Depression:
Treating depression can be different with different people. One medication effective in a person might be ineffective in another one. Typically, combination therapy is used in the following medications:
- Selective serotonin reuptake inhibitors (SSRIs)
- Selective serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants
- Monoamine oxidase inhibitors (MAOIs)
Some points to keep in mind while treating geriatric depression are:
- There may be atypical symptoms of depression.
- SSRIs should be used as first-line therapy.
- The dose should be one-half of that used in younger adults.
- Maintenance therapy is needed to avoid relapse.
If treated on time, the quality of life may increase in the elderly. Keeping a check on their healthy lifestyle and encourage and support them will help such people to alleviate the risk of geriatric depression.
I am chief medical resident doctor in Internal Medicine at a tertiary care hospital. I am also an author and editor at StatPearls publishing, a medical website with thousands of PubMed indexed articles and MCQs.