What is depression in older people?

Depression is a mental health condition that can affect people of all ages, including older people. It affects how you feel, think and manage daily activities. It can make you lose pleasure or interest in things you usually enjoy.

While it is normal to feel down sometimes, if you feel this way for 2 or more weeks, or if your mood is affecting your ability to cope with everyday life, you may be experiencing depression.

Sometimes older people think that symptoms of depression occur because of their age, poor health or dementia. Some older people prefer not to talk about depression because they feel a sense of shame or don't like to admit that they're not coping. This can lead to not seeking help, or delaying assessment and treatment for a long time.

This information is about depression in older people (over 65 years of age) but many aspects and risk factors are not age-specific. Read more on depression in the general community.

It's important to remember that not all older people become depressed. Some older people might not like to talk about how they are feeling with others or their GP. Help is available and depression in older people can get effective treatment with the right support.

What are the symptoms of depression in older people?

The symptoms of depression in older people can be different from those seen in younger adults and children. Older people are less likely to talk about the emotional symptoms of depression, such as feeling down or uninterested in activities. This may be due to long-standing stigma around mental health or because some people find it hard to say they are not coping on their own.

Older people may experience physical symptoms, but might not realise that these physical complaints are signs of depression. These might include:

• dizziness
• aches and pains
• weight loss
• difficulty sleeping or staying asleep (insomnia)
• lack of energy
• reduced fine motor function

Memory loss and challenges with concentration can also be signs of depression. If this is the case, treatment for depression can help improve your memory.

Sometimes older people, or those close to them, notice behaviour changes that may be signs of depression. These include:

• not leaving the house
• not getting out of bed
• not enjoying the things they once enjoyed doing and avoiding commitments
• neglecting their appearance
• not eating
• drinking more alcoholic drinks than normal
• hoarding unimportant items

You may experience some of these signs occasionally. If your symptoms appear often or don't go away, you may be experiencing depression.

Some older people may start thinking more about the end of life or death, or may begin putting their affairs in order, such as giving away personal items or changing their will. If you notice yourself doing this, it can be a sign of suicidal thoughts and should be taken seriously.

If you, or someone you know, is having suicidal thoughts and is in immediate danger, call triple zero (000). For help and support, call Lifeline on 13 11 14.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What causes depression in older people?

The 3 main causes of depression in older people are poor physical health, social isolation and loss in old age.

Poor physical health

Physical illness can cause depression both directly and indirectly. Medical conditions can change the way your body works and trigger depression, such as:

• vitamin deficiencies
• cancer
• thyroid disease
• infections

Older people who develop depression may also have other medical conditions. It is unusual for someone in good health to develop depression for the first time when they are over 65 years of age. It is important that older people who experience depression are checked for cerebrovascular disease — conditions that affect the blood supply to the brain.

Other medical conditions that can make it harder for you to manage by yourself include arthritis and reduced mobility. This may mean that you need to ask for more help from other people, which can result in feelings of lost dignity and worries about needing residential aged care.

Sometimes the medicines you take can play a part in depression, especially:

• blood pressure medicines
• steroids
• pain medicines

Social isolation

People can sometimes become isolated from their friends, family or communities as they age. This may be due to friends and peers passing away, or finding it harder to get around to visit people.

Loss in old age

As people age, they may experience intense periods of loss. This can be loss of a spouse, family members or friends. It can also involve loss of your health, pets or your home, if you move into residential aged-care. Loss of independence, dignity and a sense of purpose can trigger depression.

While some people cope well with these difficult circumstances, repeated loss can sometimes cause depression. If symptoms continue for a prolonged period, speak to your doctor.

Sometimes, people develop depression for no obvious reason. Just because there is no clear cause, it doesn't mean that you are not experiencing depression.

When should I see my doctor?

If you, or someone you know, is having suicidal thoughts and is in immediate danger, call triple zero (000). For help and support, call Lifeline on 13 11 14.

You should seek help and speak to your doctor if you:

• have been feeling sad or depressed most of the day
• have symptoms of depression for 2 or more weeks
• are worried that you may be depressed

If you are concerned about your mental health, or the mental health of someone you care about, contact your GP. Talking about depression and thoughts of suicide can be hard. Your doctor is a trained professional and will not judge you.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

How is depression in older people diagnosed?

To diagnose depression, your doctor will ask how you have been feeling and if you've had any physical symptoms. They may also ask about your medical and family history. They will rule out possible medical conditions (such as thyroid problems) that can mimic the symptoms of depression.

They will assess you for depression using assessments and questionnaires designed for older people.

If your doctor thinks that other health professionals should be involved, they can refer you to the right professional who can help. This could include a psychologist or psychiatrist who specialises in treating older people.

How can I help an older person with depression?

If you think an older person you know might be experiencing depression, you can help by discussing it with them and offering support.

Older people might feel stigma attached to depression or think that depression is a personal weakness rather than a medical condition. Encourage them to speak to their doctor. Remind them that being older does not mean that their depression can't be treated.

Loneliness is a major cause of depression for older people. Take the time to chat with older people or arrange a visit. This can help reduce their social isolation and prevent depression.

Read the healthdirect page on how to help someone with depression.

How is depression in older people treated?

Your doctor can build a mental health treatment plan with you. This is a plan that maps out your treatment goals and includes the services and resources available to you.

Older age does not make treatments for depression less effective.

Often, a combination of treatments works best. The main ways to treat depression are with:

• medicines
• psychological treatments
• physical treatments
• brain stimulation therapies
• self-help or alternative (complementary) therapies

Antidepressants can be less effective for older people than for younger people. But some antidepressant medicines can work for older people, especially those with severe depression. Sometimes older people can be more sensitive to antidepressants and have more side effects.

Your doctor may recommend physical treatments for depression such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

Psychotherapy, such as cognitive behavioural therapy (CBT), is popular, proven and an effective intervention for depression. If you have hearing difficulties, have low vision or have other needs, let your therapist know so they can adapt your treatment.

Self-help, alternative and complementary therapies can also be useful for older people with mild or moderate depression:

• Spend time with friends, family or the community.
• Be physically active, either alone or with a group.
• Take part in music or other therapies designed for people with depression.
• Intergenerational programs bring older adults together with children or teens in the community to build connections and support wellbeing.

Read the healthdirect article on older people and mental health for advice on improving wellbeing and where to get help.

What are the complications of depression in older people?

Depression can lead to mental health and physical complications in older people.

When depression becomes very severe, you can experience dark thoughts. These can lead to self-harm or suicide. If you are having thoughts of suicide, talking to someone you trust can help. If someone you care about has severe depression, learn the warning signs.

They may be feeling so bad that they cannot see their way out on their own.

Read more about suicide warning signs.

Depression can also make some symptoms of physical conditions and problems associated with ageing worse. If you are experiencing depression, you may be less likely to seek help for other problems that occur as you get older. If you are feeling down, speak to your doctor.

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

Can depression in older people be prevented?

There's a lot you can do to prevent depression as you get older. Some proven strategies for good mental health are:

• exercising
• eating a healthy diet
• maintaining a strong social circle
• participating in activities and hobbies that you enjoy or find meaningful
• activities that prevent cognitive decline such as playing a musical instrument, sudoku, card games or learning a new language

You can also see a psychologist even if you're not experiencing depression. This is a good way to maintain your mental health.

If you are having negative thoughts, talking with someone you trust can help. This could include:

• a GP, counsellor, psychologist or psychiatrist
• family or friends
• a teacher or coach
• a work colleague
• a religious leader

Resources and support

For telephone counselling support for people at risk and those affected by suicide, call the Suicide Call Back Service on 1300 659 467.

If you are an older person experiencing depression or think you may have depression, you could talk with a friend or a trusted doctor. You may also prefer to speak to someone you don't know, such as a telephone counsellor. Any one of these is a good first step to help you seek treatment.

Here are some helpful resources to try:

• Black Dog Institute has a fact sheet about depression in older people, including signs, types, causes and treatments. They also have a depression help and support page.
• Speak to a trained mental health professional any time of the day or night on Beyond Blue's helpline — 1300 22 4636.

• Learn how to support an older person by starting a conversation on Beyond Blue's website.
• Beyond Blue has resources to support people with depression as well as their family and friends.
• Complete Beyond Blue's K10 test to understand your level of distress and receive support options.
• Read more on what the evidence says about what treatments work for depression.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

If you are experiencing depression related to your sexuality or gender identity (LGBTQI+), QLife provides a counselling and referral service for LGBTQI+ people. You can call them on 1800 184 527 from 3pm to midnight every day.

Languages other than English

• Embrace Multicultural Mental Health has services and information available.
• This Way Up has translated resources on mental health topics.
• The Transcultural Mental Health Centre has translated mental health resources in more than 40 languages.

Information for Aboriginal and/or Torres Strait Islander peoples

• For more information on mental health and wellbeing for Aboriginal and/or Torres Strait Islander peoples, visit the Black Dog Institute.
• Beyond Blue has information on how depression affects Aboriginal and/or Torres Strait Islander peoples.
• WellMob has online resources to support mental health.
• 13YARN — for Aboriginal and/or Torres Strait Islander peoples in crisis and need support — call 13 92 76.