Depression often looks different in older adults and the elderly than it does in younger people, according to Brent Forester, MD, a geriatric psychiatrist at McLean Hospital in Belmont, Mass.
Older people tend to focus more on physical symptoms and less on emotional ones. Slow speech and a lack of attention to personal appearance may also be tip-offs to depression.
"The classic case is a widowed lady who isn't sleeping well and has lost weight," he says. "And she's not saying she's depressed. Her chief complaint is that she's nervous all the time and worried about her health. Her back hurts, she has headaches and stomach problems."
Symptoms at a glance
- Sadness, discouragement, crying
- Anxiety, panic attacks, brooding, irritability
- Say they feel sad, blue, depressed, low, nothing is fun, down in the dumps
- Loss of ability to experience pleasure
- Withdrawal from usual activities
- Feelings of worthlessness
- Unreasonable fears
- Feelings of guilt, including self reproach for minor failings
- Delusions (false fixed beliefs that are characteristic of "psychotic" depression)
- Hallucinations (false sensory experiences that characteristic of "psychotic" depression)
- Increased or decreased body movements (e.g., psychomotor agitation or retardation)
- Pacing, wringing their hands, pulling or rubbing their hair, body, or clothing
- Sleep disturbance: difficulty getting to sleep, staying asleep or especially waking up early
- Changes in appetite: usually loss of appetite but sometimes increased appetite
- Weight loss or occasionally weight gain
- Fatigue, decreased energy
- Preoccupation with physical health
- Believing they have cancer or some other serious illness when they don't (called somatic delusions)
- Difficulty concentrating, thinking or making decisions
- Slowed speech, slowed responses with pauses before answering, decreased amounts of speech, low or monotonous tones of voice
- Thoughts of death or suicide or suicide attempts
- Unusually fast heart rate
Source: Smith and Buckwalter, "When You Are More Than Just 'Down in the Dumps': Depression in Older Adults" (University of Iowa, 2006)
Depression versus grief
Symptoms of depression are often a normal reaction to loss in the elderly, says Kathleen Buckwalter, PhD, RN, professor of gerontological nursing research at the University of Iowa. "When older people lose a friend or relative, they cry, they feel sad, they feel lost, and lonely, out of sorts, or like there's no point in going on," she says. They may even lose their appetite, lose weight, and develop insomnia. These are normal responses.
However, if grief triggers severe feelings of worthlessness, psychomotor retardation (slowing of movements and thoughts), psychotic symptoms (delusions or hallucinations), or impairment in their ability to function, it is critical to seek professional mental health help.
Depression masquerades as illness
Symptoms such as extreme fatigue and sluggishness, frequent headaches and stomachaches, and chronic pain can be symptoms of other serious diseases. But they're also common symptoms of depression in older adults.
If you experience these or similar symptomsor if an older loved one exhibits these symptomsask a doctor to test for depression. Other signs of depression include feeling nervous, empty, worthless, irritable, restless, unloved, or uninterested in activities, pursuits, or people you used to enjoy.
Some older people experience dysthymic disorder, sometimes called minor depression. It may be called minor, but as with full-blown depression, it can have a serious impact on your life. Minor depression can also worsen and become full-blown depression.