What Is Geriatric Depression?
Geriatric depression, also known as late-life depression, is a type of depression that affects individuals who are sixty years or older. Depression is a serious condition at any age. However, geriatric depression is associated with an increased risk of suicide, worsening health outcomes, and hospitalizations.1
Typically, geriatric depression falls under one of four categories: major depressive disorder, persistent depressive disorder (dysthymia), substance/medication-induced depressive disorder, or depressive disorder due to a medical condition.
Is Depression a Natural Part of Aging?
Although it’s normal to feel down or sad from time to time as we age, it is important to know that clinical depression is not a natural or inevitable part of aging. Those experiencing the challenges of addiction do not have to simply accept their diagnosis and undergo it alone.
While periods of depression are common among older adults, not everyone will develop clinical geriatric depression. It is estimated that 31.74% of the elderly population struggles with clinical geriatric depression.2
Causes and Risk Factors of Geriatric Depression
There are numerous risk factors associated with geriatric depression:
Symptoms of Geriatric Depression
Geriatric depression can be difficult to catch because symptoms of geriatric depression differ from that of depression earlier in life. In other words, elderly depression signs are often different from signs of depression in younger individuals. Common symptoms of geriatric depression include:
- Apathy or feelings of emptiness
- Feelings of sadness and anxiety
- Lack of hope
- Feelings of guilt, worthlessness, or helplessness
- Suicidal ideation and possible suicide attempts
- Irritability and changes in mood
- Loss of interest and pleasure in activities
- Decrease in energy
- Difficulties with concentration or memory
- Difficulty sleeping
- Changes in eating habits
Physical Somatic Indications of Geriatric DepressionAdditionally, geriatric depression can cause physical somatic symptoms such as:
- Aches or pains
- Digestive issues
What Problems Affect Treatment of Depression in Older Adults?
Depression in older adults is often misdiagnosed or difficult to diagnose due to the presence of other health conditions. As a result, the prevalence of geriatric depression increases in medical facilities, with rates in medical outpatients ranging between 5% and 10%, medical inpatients between 10% and 12%, and long-term care facilities between 14% and 42%.3
Memory problems, dementia, and anxiety can all complicate the diagnosis of depression in older adults.
Health Condition Risk FactorsAdditionally, many underlying health conditions can lead to depression in older adults, including:
- Addison’s disease
- Certain cancers
- Cushing’s disease
- Thyroid disorders
- Parkinson’s disease
- Multiple sclerosis
- Heart disease
Medications That Can Cause Geriatric Depression
Medications usually come with a list of side effects—many of which are mild or rare. However, certain medications are known to cause depression, such as:
- Cardiovascular drugs
- Antiparkinsonian drugs
- Anti-infective agents
- Antipsychotic drugs
- Anti-anxiety drugs
- Antiretroviral drugs
Principles of Treatment for Elderly Patients
Treating depression in the elderly requires special attention to care. Often, depression in elderly individuals is related to an underlying health condition or as a side effect of medication. Underlying conditions tend to worsen with depression and should be addressed and prioritized in treating depression in older adults.
When it comes to treating geriatric depression with medication, medical professionals must take special considerations. This is because older individuals tend to be more sensitive to drug concentration, and it takes longer for their bodies to develop stable drug levels. Further, any side effects that arise tend to be more severe and take longer to resolve.
Choice of Antidepressant
There are a few different approaches to treating depression in elderly individuals. Therapy in combination with medication is an effective choice, as antidepressants are often used to manage symptoms in older adults. While there are many different options for antidepressants, efforts are taken to choose medication with minimal side effects.
However, at least 30% of individuals with geriatric depression do not respond to antidepressant medication. Thus, it is essential for medical professionals to re-evaluate the treatment plan and consider other types of medication and therapeutic methods when symptoms do not improve.4
DosingBecause of the increased risk of side effects, doctors prescribe medication for geriatric depression at lower doses and monitor the patients for complications and the emergence of side effects. Typically, half of the normal adult dose is prescribed, then increased within a week if there are no adverse effects. The medication dose gradually increases over time until the therapeutic dose is reached.
Treatment Options Available for Geriatric Depression
Interpersonal PsychotherapyInterpersonal psychotherapy focuses on the relationships that an individual has with others. This therapy aims to enhance personal relationships and the individual’s relationship with themself.
Reminiscence TherapyReminiscence therapy, or life review therapy, is another treatment for geriatric depression. Reminiscence therapy allows elderly individuals to share their stories and review their life, emphasizing identifying positive past events. Additionally, individuals are supported in reframing and accepting any negative events.
Electroconvulsive Therapy (ECT)
Not all depressed seniors respond to medication and talk therapy. In some cases, electroconvulsive therapy (ECT) is necessary to provide symptom relief for geriatric depression. ECT is safe and effective for rapid treatment. During electroconvulsive therapy, electrodes are used to transmit a mild electric current through the brain. While complications exist for ECT, it can be safer than medication for older individuals, as medications often come with side effects.
One study found that 79% of older patients with depression who received ECT experienced sustained improvement in depressive symptoms, while 75% entered remission. Another study reported that 86% of depressed patients aged fifty-six and older either recovered or improved after receiving ECT.5
Repetitive Transcranial Magnetic Stimulation (rTMS)Repetitive transcranial magnetic stimulation (rTMS) is a therapy that uses magnets to stimulate the brain. It has fewer side effects than other treatments and can be just as effective as ECT in treating geriatric depression.
Support GroupsSupport groups are also beneficial for treating geriatric depression, as they provide education, management strategies for geriatric depression symptoms, and connection with others. Good social support can act as a buffer against the effects of stressful events.
Medication is often used in geriatric depression treatment, with antidepressants being the most commonly prescribed. Nonetheless, the best antidepressant for elderly individuals will depend on the risk of side effects and any underlying conditions. Additionally, possible drug interactions must be considered when prescribing antidepressants for the elderly.
Antidepressants Used to Treat Geriatric Depression
Common antidepressants doctors prescribe to patients with geriatric depression include:
- Selective serotonin reuptake inhibitors (SSRIs): SSRIs are often the first line of antidepressant used in geriatric depression treatment. SSRIs are one of the best antidepressants for geriatric patients because they are some of the safest antidepressants for the elderly.
- Selective serotonin-norepinephrine reuptake inhibitors (SNRIs): Similarly to SSRIs, SNRIs are a safe antidepressant for the elderly. They affect not only the neurotransmitter serotonin but norepinephrine as well.
- Tricyclic antidepressants (TCAs): Tricyclic antidepressants are sometimes used in treatment but are less often prescribed because of their anticholinergic and sedating effects. Additionally, TCAs can have side effects like postural hypotension or heart abnormalities.
- Monoamine oxidase inhibitors (MAOI): MAOIs are also used in treating geriatric depression, but less so than newer drugs. MAOIs may lead to changes in blood pressure and have a high risk of food-drug interaction.
- Bupropion: Bupropion is an antidepressant commonly used in treating depression in older adults. It is a popular choice of antidepressant for the elderly because it is well tolerated in older individuals and has a lower risk of side effects.
- Mirtazapine: Mirtazapine, also known as Remeron, is used in geriatric depression treatment. This drug is also often used for depressed seniors who are also struggling with dementia.
Self-Help for Elderly Depression
While getting help from a professional is key in geriatric depression treatment, there are some things individuals can do on their own to improve their quality of life. Here are a few self-help tips that are helpful in both prevention and management:
Write Your MemoirsLife is filled with fantastical and wonderful experiences. It can be helpful to reflect on the past and process life’s events. Journaling and memoir writing can be immensely healing and bring attention to all the positive and joyful events that were experienced.
Take Care of a PetLoneliness is a common problem for many people, especially older adults. Individuals who are single, divorced, or widowed and living by themselves have a higher risk of developing depression. Getting a furry companion or pet can help alleviate loneliness, cultivate joy, and provide a sense of purpose. Many animal shelters and rescues also have programs to match seniors with appropriate animal companions, often at a discount.
Join a Depression Support GroupSupport groups are an excellent complement to geriatric depression treatment. Support groups connect depressed individuals with resources and provide a wealth of education and management strategies. Additionally, joining a support group provides people with a sense of community and offers opportunities to give back to others.
Create Opportunities to LaughLife is meant to be enjoyed, and it’s important to find opportunities for joy and laughter as the years pass by. Laughter is a powerful medicine that is effective for all ages. Cultivating laughter can look like learning a new skill, spending time with friends and loved ones, or just pursuing whatever makes the heart happiest.
Get Involved in Your CommunityMany depressed seniors find relief from depressive symptoms by getting involved in their communities. Helping others feels good, and the connections made from helping others can be incredibly powerful in healing depression on a personal level. Community involvement can also boost self-esteem.
TravelWhen was the last time you experienced something for the very first time? Traveling and experiencing something new can help individuals rediscover their zest for life. Traveling as an older adult can seem daunting, but there are many programs that offer safe travel experiences and tours for seniors to make traveling more accessible.
Eat to Support Your MoodDiet can play a major role in mood and the development of depression. Eating a healthy, well-balanced diet can improve outcomes for depression and act as a preventative measure.
Spend Time in SunlightSunlight is both charging and healing. Getting out and spending a little bit of time in the sunlight can do wonders for a person’s mood.
Get Professional Help for Geriatric Depression at Genesis Recovery
Geriatric depression is serious and can have devastating effects on an individual if they do not receive help. Genesis Recovery offers evidence-based and holistic therapies that tend to the needs of the whole individual, not just treating symptoms.
We understand that treatment is not a one-size-fits-all process, as every situation is different and needs can change along the recovery journey. Thus, we offer many levels and types of treatment to ensure every patient receives the care they require and deserve.
TherapiesAt Genesis Recovery, our therapies are spiritually minded with an experiential focus. We believe in helping people find connection with each other, themselves, and the planet through therapy. We also understand that traditional talk therapy doesn’t work for everyone, so we provide a custom therapeutic approach tailored to the individual’s interests.
Genesis Recovery offers high-quality inpatient care for individuals needing a little more support. Inpatient care is the safest and most effective choice for treatment for those with severe depression and suicidal ideation.
Inpatient care allows patients to stay at our facility to receive twenty-four-hour care and support. Our inpatient program is also one of the fastest ways to connect individuals with resources and get the effective help that they need.