Depression in older people: signs and how to support treatment
How to recognise depression in an older person, how it is treated and what the family can do to help the treatment work.
In short
- Depression is not a normal part of ageing: it can be treated and it is worth seeing the GP.
- In older people it is mistaken for tiredness, poor appetite or sleep problems, and in severe cases it can look like dementia.
- Antidepressants usually start to have an effect in 1 to 2 weeks, take up to 8 weeks to work fully and should not be stopped suddenly.
- If there are thoughts of suicide, call Spain's 024 helpline, free and available 24 hours a day, or 112 if there is immediate danger.
Depression in older people is common, it can be treated and it should not be mistaken for normal ageing. If you notice sadness, apathy or loss of interest in your father or mother that lasts for weeks, the right step is to see their GP.
According to the World Health Organization (WHO), around 15% of adults aged 70 or over live with a mental disorder, most often anxiety or depression. In this article we explain how to recognise it and how the family can help, including with medication.
| What will you find in this article? |
How does depression show itself in an older person?
In older people depression can be hard to spot, because tiredness, poor appetite or sleep problems are put down to age or other illnesses. In severe cases its symptoms can look like those of dementia.
- Sadness, frequent crying or feeling worthless or hopeless.
- Loss of interest in activities or people they used to enjoy.
- Tiredness, changes in appetite or weight and sleep problems.
- Withdrawal: they stop going out, phoning people or looking after their appearance.
- Difficulty concentrating or new forgetfulness.
- Neglecting their health, for example stopping their medication.
What increases the risk of depression in later life?
Life changes and physical illness are the main triggers. The WHO identifies loneliness and social isolation, which affect around one in four older people, as key risk factors.
| Type of factor | Examples |
|---|---|
| Losses and changes | Death of a partner or friends, retirement, moving home or loss of independence |
| Physical health | Chronic pain, thyroid problems, Parkinson's, heart disease, cancer, stroke or dementia |
| Surroundings | Loneliness, isolation, low income or abuse |
| Substances | Too much alcohol or certain medicines, such as sleeping tablets |
Caring for years for a partner with a long term illness, such as dementia, can also overwhelm the carer.
How is it treated and what should you know about antidepressants?
Treatment starts by reviewing physical illnesses and medicines that may be worsening mood, and usually combines talking therapy, social support and, when the doctor considers it appropriate, antidepressants. In older people antidepressants are usually started at lower doses and increased more slowly than in younger adults.
- They usually start to have an effect in 1 to 2 weeks and can take up to 8 weeks to work fully.
- They are normally continued for at least 6 months after the person feels better.
- They should not be stopped suddenly: the doctor will explain how to reduce the dose gradually.
- Some side effects ease after a couple of weeks; if one worries you, mention it to the doctor or pharmacist.
Stopping an antidepressant because it "does nothing" in the first few days is a common mistake. Explaining these timescales helps the person stick with the treatment.
What can the family do to support treatment?
The family can help a great deal through presence, routines and well organised medication. Depression saps energy and memory, so it is common for the person to miss doses or stop them without saying so.
- Go with them to appointments and help them explain what you have noticed.
- Keep in frequent contact and suggest simple social activities.
- Encourage them to stay active if their doctor considers it safe, and to look after their sleep.
- Check discreetly that they are taking their medication; you will find ideas in how to know whether your parents are taking their medication.
- If they refuse to take it, read our guide on what to do if an older person refuses their medication.
If they talk about dying or taking their own life, take it seriously: the Spanish Ministry of Health's 024 helpline is free, confidential and open 24 hours a day, including for relatives. If there is immediate danger, call 112 and do not leave them alone.
A practical example: Pilar after being widowed
Take the case of Pilar, 80, who was widowed a year ago. Her son notices that she no longer goes to the community centre for older people, eats little and says she "does not feel like doing anything any more". He also finds several untaken doses of her blood pressure medication in her pill organiser.
- Her son books an appointment with the GP and goes with her.
- The GP assesses her mood, reviews her medication and suggests psychological support and an antidepressant.
- At home they agree on daily phone calls and on restarting a weekly activity with a neighbour.
- They explain to her that the antidepressant will take weeks to show an effect, so she does not stop it.
- They organise her medication dose by dose so it is easy to check whether it has been taken.
How can IMA Health help?
When mood is low, keeping medication in order is harder. IMA Health coordinates with a specialised pharmacy that prepares the medication by the day and time of each dose, delivers it to the home and provides personalised follow-up that gives the family more peace of mind.
Sources
- Spanish Ministry of Health: 024 suicide prevention helpline (Spanish)
- WHO: Mental health of older adults
- MedlinePlus: Depression in older adults (Spanish)
- NHS: Antidepressants, overview
This article is for information only and does not replace advice from your doctor or pharmacist.