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Is Depression a Normal Part of Aging?

Natural changes in an individual’s physical and cognitive state occur as a result of aging. But does depression naturally follow these changes?

Decreased muscle strength and flexibility, wrinkled skin and vision changes are just a few of the common physical changes which occur with the aging process. Cognitively, the mind may become less sharp due to decreased blood flow to the brain, changes in diet or decreased stimulation.

Depression is a prolonged sense of emptiness or hopelessness, and a loss of interest in activities. It may last for an extended period of time and affect the individual’s ability to complete the tasks of daily living, or it may present as a chronic attitude of gloominess while the individual continues to function.

Symptoms can include: loss of appetite or overeating; decreased concentration; frequent feelings of irritability, anxiety, sadness or guilt; problems sleeping or sleeping all the time; difficulty making decisions; general fatigue; and frequent aches and pains. Many of these symptoms can also be the result of other disease processes or the side effects of medications.

If an older adult simply accepts some of these symptoms as part of “getting older,” he/she may not verbalize the presence of the symptoms to a physician or family members, thus making an accurate diagnosis difficult. In addition, depression may sometimes be mistaken for dementia or delirium, due to a similarity of symptoms: A thorough review of the individual’s mental functioning can help distinguish between these conditions.

A number of factors can contribute to depression in an older adult.

A family history of depression results in a greater likelihood that an individual will develop depression. Side effects of medications may cause or increase symptoms of depression. In addition, differences in brain chemistry or the presence of certain health conditions, such as thyroid disorders or a vitamin B12 deficiency, may place individuals at a greater risk for developing depression. Vascular depression is caused by decreased blood flow to the brain due to the stiffening of blood vessels as one ages.

Stress caused by life changes is a primary risk factor for the development or worsening of depression in the older population. Potential stressors include social isolation, chronic pain or disease, loss of a spouse or close friends, a move from one’s home, financial insecurity, and/or loss of independence (such as giving up driving).

Whether or not these stressors lead to depression is influenced by the individual’s perception of the stressor, ability to cope, and social support system.

Depression can be treated in a number of ways.

First, it is important to determine if the depression is related to another illness or a medication. Discuss the presence of all symptoms with a physician, whether or not they seem significant or related to each other. In addition, the physician should be aware of all medications that are being taken, including vitamins, herbal remedies and over-the-counter products. Avoiding alcohol, illegal drugs and sleep aids can help in reducing symptoms of depression. Exercise can provide both physical and emotional benefits by increasing the presence of certain chemicals in the brain that cause one to “feel good,” providing a distraction from negative thoughts, and allowing opportunities for increased socialization.

If antidepressant medications are started, be aware that it may take several weeks before any result is felt. Counseling or psychotherapy services may be needed if other interventions are ineffective. Often, a combination of treatments works better than a single treatment.

Is depression a normal part of the aging process? No it is not.

It is important to diagnose and treat depression in older adults because depression contributes to higher mortality rates. In addition, a depressive episode that is untreated or under-treated can lead to a more intense episode of depression in the future.

At any age, depression is painful to experience personally, or to watch a loved one experience. Accurate diagnosis and compliance with treatment can improve the quality of life not only for the individual, but for family members as well.

Karen Kaslow, RN, BSN