Geriatric depression: Symptoms, causes, treatments, more

Jennifer E. Engen

Geriatric depression is a mental health condition affecting older adults. As with depression in younger adults, depression in older people can have many different causes and treatment options.

Although geriatric depression is the most common of all mental health conditions in adults 65 years and older, health experts do not consider it a typical part of aging.

Symptoms of depression in older adults may include persistent feelings of sadness, loss of energy, and reduced interest in activities that a person once enjoyed.

Treatment may consist of medication, psychotherapy, or alternative therapies.

This article provides an overview of geriatric depression, including the various symptoms, causes, and available treatment options.

According to the World Health Organization (WHO), while most older adults have good mental health, many are at risk of developing mental health conditions such as depression.

Geriatric depression is a mood disorder in older adults that involves a persistent loss of interest and feelings of sadness.

The Centers for Disease Control and Prevention (CDC) estimate that, in the United States, 7 million adults aged 65 years or older experience depression every year.

However, the United Kingdom’s Royal College of Psychiatrists notes that depression can affect 1 in 5 older adults living in a community or 2 in 5 living in a care home.

Symptoms of depression can vary from one person to another.

Some of the most common signs and symptoms of depression in older people include:

  • a low or sad mood
  • fatigue or loss of energy
  • lack of interest in activities once enjoyed
  • feeling guilty, hopeless, or worthless for no reason
  • difficulty thinking, concentrating, or making decisions
  • too much sleep or too little sleep
  • aches or pains
  • digestive issues
  • changes in appetite
  • restlessness
  • irritability
  • withdrawal from friends and families
  • suicidal thoughts or attempts

A healthcare professional can help a person rule out underlying causes of geriatric depression. They can also offer effective treatments and self-care tips.

Geriatric depression can make people think of harming themselves, including thoughts of suicide. If an older adult has these thoughts, they or someone else should seek immediate help by calling the National Suicide Prevention Lifeline at 800-273-8255 or the local emergency number.

Healthcare professionals do not know the exact cause of geriatric depression, but they have been able to identify some possible factors. A combination of these factors can trigger depressive symptoms in older adults.

According to the U.K.’s National Health Service (NHS), these include:

  • Genetics: People with a family history of depression are two to three times more likely to have geriatric depression. Also, research suggests that depression is 30–50% due to genetics.
  • Brain chemistry: Imbalances in the neurotransmitters responsible for mood regulation can cause depression. Neurotransmitters are chemical messengers that regulate biological processes in the body. Research suggests that changes in the brain’s neurotransmitter levels may contribute to depression.
  • Brain structure: A 2018 study indicates that people who develop depression may have an abnormality in the frontal lobe of their brain.
  • Certain medical conditions: People living with medical conditions such as diabetes, arthritis, cancer, heart disease, and chronic pain have a greater chance of developing depression. Also, depression may occur alongside health conditions associated with aging.
  • Stress: Stressful life events such as losing a loved one, divorce, and lack of a support system in old age can increase a person’s chances of geriatric depression.
  • Female sex hormones: People with female sex hormones are twice more likely to have depression than biological males. This may be due to changes in the levels of estrogen and progesterone during different life stages, which can trigger depressive episodes.
  • Substance use: People with a history of alcohol use disorder (AUD) or substance use disorder (SUD) may be at higher risk for depression. This may be because substance misuse can intensify the feelings of sadness and loneliness that experts often associate with depression. Also, research has linked certain medications such as anticonvulsants, beta-blockers, benzodiazepines, statins, stimulants, and corticosteroids with depression.

If an older adult has signs and symptoms of depression lasting at least 2 weeks, a doctor may diagnose geriatric depression.

However, before coming up with a diagnosis, a doctor will take a person’s medical history and use a geriatric depression scale when asking about symptoms of depression to understand how long they have been present.

The doctor will also perform a physical examination and order a blood test to rule out any underlying cause before providing treatment.

Geriatric depression is treatable, and treatment options may include medication, psychotherapy, and other alternative therapies.

Medication

A healthcare professional may prescribe any of the following antidepressants:

  • Selective serotonin reuptake inhibitors (SSRIs): SSRIs treat depression by increasing the serotonin levels in the brain. Sertraline is a common and effective SSRI that treats depression in older adults. Other medications include escitalopram and citalopram.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): SNRIs work by producing more serotonin and norepinephrine in the brain. Doctors may suggest them if SSRIs have been unsuccessful. Venlafaxine and duloxetine are examples of SNRIs. Health experts consider SNRI medications safe and effective in treating depression in older people due to fewer side effects.
  • Monoamine oxidase inhibitors (MAOIs): Doctors can prescribe MAOIs when all other antidepressants are ineffective. MAOIs stop monoamine oxidase from removing dopamine, serotonin, and norepinephrine from the brain. Examples are isocarboxazid and phenelzine. Some people may experience high blood pressure due to elevated tyramine levels from MAOIs. Health experts recommend that people taking MAOIs monitor their blood pressure and avoid tyramine-rich foods such as dried sausage, fermented soy products, and improperly stored foods.
  • Tricyclic antidepressants (TCAs): TCAs can treat depression by increasing the amount of serotonin and norepinephrine in the brain. Doctors rarely administer TCAs as a first-line treatment for geriatric depression because they may cause irregular heart rates and falls in older adults. Examples include amitriptyline and amoxapine.
  • Atypical antidepressants: These act differently from other antidepressants. Atypical antidepressants change the brain chemistry to help relieve depression. Some examples are bupropion and nefazodone.

A person should take and complete these medications as prescribed by their doctors, even after symptoms improve, until their doctor says it is safe to stop.

However, if a person has any concerns about their antidepressants, they should discuss them with their doctor.

Psychotherapy

Research from 2017 has shown that psychotherapy can improve symptoms in people with geriatric depression.

Psychotherapy, also known as talk therapy, may include interpersonal and cognitive behavioral therapy (CBT). CBT teaches a person new ways to think and behave and change habits that can cause depression by encouraging positivity.

Interpersonal therapy may also be an effective option. Its goal is to help people identify and change emotional challenges affecting mood.

Electroconvulsive therapy (ECT)

If geriatric depression is severe and does not respond to medication or psychotherapy, a doctor may suggest ECT.

ECT is a form of brain stimulation that uses electrical current to activate the brain and treat depression.

According to a 2016 review, ECT is a safe and effective treatment option for older adults living with depression.

Depression affects younger people and older adults differently.

The National Institute of Mental Health (NIMH) notes that while younger people receive most depression diagnoses, depression may occur at any age, including in older adults. This may be due to health conditions, losing loved ones, and other complications people associate with aging.

Also, unlike in younger people, sadness is often not recognized as a significant symptom of depression in older adults. Older people may have other signs of depression that a doctor does not easily detect. This can make geriatric depression challenging to diagnose.

For this reason, older adults should speak with a doctor and discuss any feelings they may have if they notice signs of depression.

Insomnia is a sleep disorder where people have difficulty falling or staying asleep.

In older adults, sleep problems can predict the onset of geriatric depression. According to a 2017 review, insomnia can increase the risk of depression in older people and vice versa.

The National Sleep Foundation (NSF) notes that insomnia affects a person’s energy levels and mood and can lead to conditions including depression and anxiety. The NSF reports that 57% of older adults experience a decline in overall health and quality of life due to insomnia.

If a person has symptoms of insomnia, they should speak with their doctor. A doctor will assess a person’s symptoms and choose the best medications to treat sleep problems.

While older adults may not be able to prevent most cases of geriatric depression, treatment can offer significant long-term benefits and alleviate worsening symptoms.

A healthcare professional will assess a person’s symptoms and choose the right combination of medications and therapies.

The NIMH states that if a person starts treatment soon, they may see improvements 2 weeks after treatment begins and can prevent future episodes.

Without treatment, episodes can last several weeks or longer. This can affect a person’s quality of life and increase the risk of suicide in older adults.

Geriatric depression is a condition that affects older adults.

For some people, symptoms may be transient, while they may persist over years for others.

For people living with the condition, treatment can improve their quality of life. A doctor may prescribe antidepressant medications, psychotherapy, or alternative therapies.

https://www.medicalnewstoday.com/articles/geriatric-depression

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