How to Lift Late-Life Depression

Health Writer
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Growing older often brings a kind of wisdom — the ability to see your life with greater clarity and the perspective to appreciate all that’s right with it, such as your family and the time to travel and enjoy your hobbies. Yet this time of life can bring sadness, too.

While chronic illness, reduced mobility, the death of friends or a partner, and social isolation can lead to depression, it may develop without any identifiable trigger.

Nearly 14 percent of people 55 and older are depressed, according to a review published in May 2017 in the Journal of the American Medical Association. About 2 percent have major late-life depression — a combination of persistently depressed mood and other symptoms severe enough to disrupt their lives. Although the prevalence of depression declines with age, it spikes among people in their 80s.

Some adults have been dealing with depression for much of their lives. Others experience it for the first time late in life. Either way, persistent sadness and late-life depression are important to address.

Missed signs equals poor prognosis

Many depression symptoms, like sadness, a loss of interest in daily activities, and trouble sleeping are easy to identify. Yet as you age, depression doesn’t always manifest in these obvious ways.

Some signs of depression in older adults are more subtle or mimic symptoms of other medical conditions, according to the JAMA review. Other signs, including fatigue, weight loss, pain, and vague complaints like headaches and stomachaches, can be mistaken for another health issue.

Drug side effects can also induce or mimic depression. And memory problems from depression can be difficult to tell apart from permanent dementia.

Many older adults mistakenly believe their sadness is just a normal result of aging. Others tend to be embarrassed or reluctant to seek professional help for emotional problems, partly because the stigma of psychiatric illness is especially strong among people in this age group or because they remember the days when treatments were less effective.

Depression can also induce unrealistic hopelessness and undermine the initiative to seek and continue in treatment. Unfortunately, most cases of late-life depression are inadequately treated — or not treated at all. Many older adults are treated with doses of antidepressants that are too low or treatment is stopped too early.

Untreated depression is likely to intensify and can worsen coexisting conditions like diabetes and high blood pressure, making them harder to control. It can increase the risk of early death and repeated hospitalization. It can also put you at risk for suicide. It’s important to get help for your symptoms — especially if you’ve had thoughts of hurting yourself.

Finding the best treatment

Many people with mood disorders are treated by a primary care doctor, who initially will rule out an underlying condition that could be causing depressive symptoms. If depression is the main diagnosis, the doctor can start drug therapy or coordinate care with a mental health professional.

Treating depression often requires persistence. It may take a few tries to find the right therapy, which depends on the severity and frequency of your depression, your overall health, and your preferences. Here are some options.

  • Psychotherapy. Typically the first line of treatment for mild to moderate depression, it can help some people with major depression in combination with antidepressants. But if you can’t tolerate antidepressants or would prefer not to take drugs to help alleviate depression, psychotherapy can be an effective alternative with few physiological side effects. However, psychotherapy typically takes longer than drug therapy to produce noticeable benefits.

For major depression, its effectiveness is similar to that of antidepressants. Cognitive behavioral therapy (CBT) is one of the best-studied forms of psychotherapy for depression. In CBT, a therapist helps you learn to override negative thinking patterns and deal with challenges in a more positive way. A course of therapy lasts two to four months and is usually covered by health insurance.

  • Antidepressants. For major depression, antidepressants — specifically, selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro), paroxetine (Paxil), and sertraline (Zoloft)—are often a first treatment choice for major depression.

They are frequently combined with psychotherapy for added effectiveness. Most people tolerate these medications well, but they can cause side effects, including tremors, agitation, weight loss or gain, slowed heartbeat, and falls leading to fractures; the drugs are also associated with an increased risk of osteoporosis.

Side effects may be severe in older adults who are frail or ill. Another downside of antidepressant therapy is a possible interaction with other drugs you’re taking.

Antidepressants can produce a significant improvement by four to eight weeks, although it may take 12 to 16 weeks to see the full benefit. You may need to keep taking your antidepressant for a year after your symptoms fully abate — longer if you have a history of prior episodes of depression.

About two-thirds of older adults with major depression won’t respond to initial treatment. Your doctor may switch you to another class of antidepressants if your medication doesn’t help.

  • Electroconvulsive therapy. If antidepressants and psychotherapy don’t work, another option is electroconvulsive therapy (ECT). Though the name might sound frightening — especially because it was once known as “shock therapy” — ECT is a safe and effective method to treat major depression, even for people 85 and older. It’s also used for patients with severe depression at high risk for suicide since it can work more quickly than antidepressants.

Some studies suggest that it’s effective in up to 80 percent of older patients. ECT is administered through electrodes placed over your scalp through which a small electrical current is applied while you’re under general anesthesia. The current induces a cerebral seizure.

Doctors don’t know exactly how ECT helps with depression, but they think its benefit comes from triggering the release of neurotransmitters such as serotonin and dopamine.

ECT is typically administered three times a week. Most patients see symptom improvement after six to 12 treatments, although some may improve in just three sessions.

Side effects include confusion and memory loss, which are usually temporary. Your doctor may recommend occasional maintenance therapy after successful treatment. Many health plans and Medicare cover the procedure.

  • Exercise. Several studies have shown that exercise can alleviate depression and improve mood. Cardiovascular, or aerobic, exercise in particular has been shown helpful for depression. Researchers speculate that it works by stimulating brain chemicals like serotonin and norepinephrine.

Exercise also stimulates the release of feel-good chemicals called endorphins, which reduce pain and create a feeling of euphoria. Exercise may also improve disturbed sleep.

Any increase in activity can be beneficial. Try parking your car farther away from the store to increase the amount of time you spend walking. Take the stairs instead of the elevator.

Consider walking, working in your garden, swimming at your local gym. Aim for 30 minutes of movement a day—even if you have to split the time into three 10-minute sessions.

Speak up

If you think you may be experiencing depressive symptoms, discuss your concerns with your doctor or another trusted health professional. Getting the right treatment will help you manage symptoms and likely improve your quality of life. And once you find relief, you still need to be alert for returning symptoms.

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