Depression, one of the most common conditions associated with
suicide in older adults,1
is a widely underrecognized and undertreated medical illness. In
fact, several studies have found that many older adults who die by
suicide—up to 75 percent—have visited a primary care physician
within a month of their suicide.2
These findings point to the urgency of improving detection and
treatment of depression as a means of reducing suicide risk among
Older Americans are disproportionately
likely to die by suicide. Comprising only 13 percent of the U.S.
population, individuals age 65 and older accounted for 18 percent of
all suicide deaths in 2000. Among the highest rates (when
categorized by gender and race) were white men age 85 and older: 59
deaths per 100,000 persons in 2000, more than five times the
national U.S. rate of 10.6 per 100,000.3
Of the nearly 35 million Americans age
65 and older, an estimated 2 million have a depressive illness
(major depressive disorder, dysthymic disorder, or bipolar disorder)
and another 5 million may have “subsyndromal depression,” or
depressive symptoms that fall short of meeting full diagnostic
criteria for a disorder.4,5
Subsyndromal depression is especially common among older
persons and is associated with an increased risk of developing major
In any of these forms, however, depressive symptoms are not a
normal part of aging. In contrast to the normal emotional
experiences of sadness, grief, loss, or passing mood states, they
tend to be persistent and to interfere significantly with an
individual's ability to function.
Depression often co-occurs with other
serious illnesses such as heart disease, stroke, diabetes, cancer,
and Parkinson’s disease.7
Because many older adults face these illnesses as well as various
social and economic difficulties, health care professionals may
mistakenly conclude that depression is a normal consequence of these
problems—an attitude often shared by patients themselves.8
These factors together contribute to the underdiagnosis and
undertreatment of depressive disorders in older people. Depression
can and should be treated when it co-occurs with other illnesses,
for untreated depression can delay recovery from or worsen the
outcome of these other illnesses. The relationship between
depression and other illness processes in older adults is a focus of
Both doctors and patients may have
difficulty identifying the signs of depression. NIMH-funded
researchers are currently investigating the effectiveness of a
depression education intervention delivered in primary care clinics
for improving recognition and treatment of depression and suicidal
symptoms in elderly patients.9
Research and Treatment
Research has revealed varying patterns
of clinical and biological features among older adults with
As compared to older persons whose depression began earlier in life,
those whose depression first appears in late life are likely to have
a more chronic course of illness. In addition, there is growing
evidence that depression beginning in late life is associated with
vascular changes in the brain.
Both antidepressant medications and
short-term psychotherapies are effective treatments for late-life
Existing antidepressants are known to influence the functioning of
certain neurotransmitters in the brain. The newer medications,
chiefly the selective serotonin reuptake inhibitors (SSRIs), are
generally preferred over the older medications, including tricyclic
antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs),
because they have fewer and less severe potential side effects.10
Both generations of medications are effective in relieving
depression, although some people will respond to one type of drug,
but not another.
Research has shown that certain types
of short-term psychotherapy, particularly cognitive-behavioral
therapy and interpersonal therapy, are effective treatments for
In addition, psychotherapy alone has been shown to prolong periods
of good health free from depression. Combining psychotherapy with
antidepressant medication, however, appears to provide maximum
benefit. In one study, approximately 80 percent of older adults with
depression recovered with combination treatment.11
The combination treatment was also found to be more effective than
either treatment alone in reducing recurrences of depression.12
More studies are in progress on the
efficacy and longer-term effectiveness of SSRIs and specific
psychotherapies for depression in older persons. Findings from these
studies will provide important data regarding the clinical course
and treatment of late-life depression. Further research will be
needed to determine the role of hormonal factors in the development
of depression in older adults, and to find out whether hormone
replacement therapy with estrogens or androgens is of benefit in the
treatment of late-life depression.
Before you say,
Ask yourself if you feel:
and slowed down |
enjoy things the way you used to |
and irritable |
like no one
loves you |
is not worth living |
more or less than usual |
or less than usual |
persistent headaches, stomach aches, or chronic pain
These may be syptoms of Depression,
a treatable medical illness.
But your doctor can only treat you if
you say how you are really feeling.
Depression is not a normal part of
Talk to your doctor
For More Information
Please visit the following links for
more information about organizations that focus on
All material in this
fact sheet is in the public domain and may be copied or reproduced
without permission from the NIMH. Citation of NIMH as the source is
NIH Publication No. 03-4593
Printed January 2001
Revised May 2003
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