Depression is common in later life, but it is not a normal part of getting older. The National Institute on Aging puts it plainly: most older adults feel satisfied with their lives, even with more illnesses than younger people. When low mood, flatness or loss of interest settle in for weeks, it deserves the same attention as any other medical problem.

The difficulty is that depression in older adults often does not look the way people expect.

Why it is easy to miss

The NIA notes that for some older adults, sadness is not the main symptom. Instead they may feel numb, lose interest in things they used to enjoy, or simply not talk about feelings the way younger adults might. In some people depression shows up mainly as physical complaints: aches, headaches, digestive problems.

It also overlaps with other things that happen with age. Poor sleep gets blamed on getting older. Fatigue gets blamed on a heart condition or a new medicine. Forgetfulness raises worry about dementia, when trouble concentrating can be a symptom of depression.

Signs to watch for

The NIA lists these common symptoms in older adults. If several last more than two weeks, talk with your doctor:

  • A persistent sad, anxious or empty mood
  • Feeling hopeless, guilty, worthless or helpless
  • Irritability or restlessness
  • Loss of interest in activities you used to enjoy
  • Low energy or fatigue, or moving and talking more slowly
  • Trouble concentrating, remembering or making decisions
  • Sleeping poorly, waking very early, or sleeping too much
  • Eating more or less than usual, with weight gain or loss you did not intend
  • Drinking more, or taking more risks
  • Thoughts of death or suicide

Family members often notice first: a parent who stops calling friends, skips the weekly card game, lets the mail pile up or seems short-tempered. Those changes are worth a gentle question.

Who is at higher risk

The NIA links a higher risk of depression to serious illness such as stroke or cancer, a personal or family history of depression, caregiver stress, sleep problems, loneliness and isolation, low physical activity, limits on daily activities, and alcohol misuse. Major losses, including the death of a spouse, retirement or a move away from friends, can set it off.

Depression and dementia also overlap. The NIA notes that depression is common in people with dementia, and that it can sometimes be an early warning sign. That is one more reason to have changes in mood or memory looked at rather than waiting.

Getting checked and getting treated

The U.S. Preventive Services Task Force recommends screening all adults for depression, and its 2023 statement explicitly includes adults 65 and older. Screening is usually a short set of questions at a regular visit.

A good evaluation also looks for other causes. Certain medicines and medical conditions can produce the same symptoms, and the NIA notes that a doctor can rule these out with an exam, a careful history and lab tests. Side effects of common medicines are one example worth checking.

Treatment works for most people. The main options are:

  • Talk therapy, such as cognitive behavioral therapy or interpersonal therapy, with a psychologist, licensed clinical social worker or psychiatrist.
  • Medicines, most often SSRIs in older adults. Because aging changes how the body handles drugs, the starting dose and possible interactions need care.
  • Both together, which is common.
  • Other treatments, such as brain stimulation therapies, for depression that has not improved with the usual approaches.

The NIA notes it is common to try more than one treatment before finding the right fit, and that outpatient mental health care is generally covered by Medicare and private insurance. Regular activity, sleep and staying in touch with people help alongside treatment, though they do not replace it.

If someone is in crisis

If you or someone you love is thinking about suicide, call or text 988, the Suicide and Crisis Lifeline, available 24 hours a day. If there is immediate danger, call 911. The NIA notes that asking someone directly whether they are thinking about suicide does not make them more likely to act on it, and can help them open up.

Related reading: memory changes and when to see a doctor, hearing loss and memory, and reviewing medicines in older adults.

At Legacy Medical, visits are unhurried, which makes it easier to bring up mood, sleep or grief. Dr. Shtern checks for medical causes, reviews every medicine, and refers to a mental health professional when that is the right step. Families of older patients can read more on care for families. To meet her first, the first visit is a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.