Is My Dad Depressed?

The question of depression comes up frequently in my conversations with the children of aging parents – especially when there has been a recent significant loss. In answering this question it is important that we understand what depression is, how it is manifested differently among seniors and what are the things that mimic, or look like depression.

I think of depression as an impairment of mood that usually results in subjective distress and interferes with social and/or occupational functioning. It can result from internal factors or a response to external situations. Depression is not a normal part of the aging process. It occurs in 5-9% of women and 2-3% of men in the population at large and in about 5% of healthy elderly people. The prevalence of depression increases dramatically among those who are chronically ill and those living in residential care settings.

The symptoms of depression include: depressed mood (feelings of sadness sometimes accompanied by tearfulness), anhedonia (loss of interest in things that used to be enjoyable), weight loss/gain, insomnia/hypersomnia, fatigue, feelings of worthlessness and/or hopelessness, excessive guilt, problems with attention and decision making, and when severe can include persistent thoughts about death and suicidal ideation and/or intent.

Among seniors anhedonia is usually the primary symptom and depressed mood (the subjective feeling of being depressed) may be denied. The older depressed person is more likely to present with somatic symptoms (physical complaints for which there is no identified illness, or that are in excess of what would be expected for an illness). Cognitive symptoms may also be prominent particularly short-term memory loss and mental slowing.

If you think that your aging loved one may be depressed ask yourself – has there been a notable change in their involvement in the things that used to be enjoyable to them? Are they sleeping and eating well? Does there appear to have been a significant change in their mental capacity or short-term memory? If you answered yes to any of these questions then there your loved one should be evaluated for depression. I recommend starting the evaluation process with a physician who specializes in the treatment of older adults because he/she will know the medical conditions to assess that may be responsible for the symptoms. There are many systemic, neurologic and iatrogenic (caused by treatments – for example medication side-effects) that can cause or exacerbate depressive symptoms.

If the physician believes the person is depressed she/he can prescribe various treatments including counseling and/or medications. Both counseling and the newer anti-depressant medications have been found to be effective in the treatment of depression in older adults.