What is depression in older people?

Depression is a mental health condition that can affect people of all ages including older people. While it is normal to feel down sometimes, if you feel this way for 2 weeks or more, or your mood is affecting your ability to cope with everyday life, you may be experiencing depression.

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

This information is about depression in older people; however, many aspects and risk factors are not age-specific. Read more on depression in the general community.

How common is depression in older people?

More than 1 in 10 older people, and more than 3 in 10 people living in residential aged-care, experience depression.

It’s important to remember that not all older people become depressed. However, older people are more likely not to talk about their depression with others and only seek help when things are really bad. Help is available and depression in older people can be treated effectively. With the right treatment most older people can recover.

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 such as vitamin deficiencies, cancer, thyroid disease and even infections can change the way your body works and trigger depression.

People who develop depression when they are over 60 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 60. It is important that older people who experience depression are checked for cerebrovascular disease — diseases that affect the blood supply in 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 loss of dignity and worries about the need for 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 it becomes 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 and can also involve loss of your health, pets or your home. Loss of independence and dignity can sometimes trigger depression too.

While some people cope well with these difficult circumstances, repeated loss can sometimes cause depression if symptoms continue longer than 3 to 6 months after a loss or change.

What are the signs of depression in older people?

The signs of depression in older people are 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 might be because of old stigmas around mental health or because people sometimes find it hard to admit that they are not coping by themselves.

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

• dizziness
• aches and pains
• weight loss
• difficulty sleeping or staying asleep (insomnia)

Memory loss can also be a sign of depression and if this is the case, treatment for depression can help improve your memory.

Sometimes older people or people close to them notice changes in behaviour, which can be a sign of depression. These include:

• not leaving the house
• not enjoying the things they once enjoyed doing
• not eating
• drinking more alcoholic drinks than normal
• hoarding unimportant items

Another sign of depression is thinking a lot about the end of your life. You may find yourself giving away personal possessions, changing your will, or talking a lot about death. This can be a sign of suicidal thoughts and should be taken very seriously.

Suicide and crisis support: If you or someone close to you is in crisis, or at immediate risk of harm, call triple zero (000). To talk to someone now call Suicide Call Back Service 1300 659 467 or Lifeline 13 11 14.

When should I see my doctor?

If you — or someone close to you — shows signs of depression for 2 weeks or more, or you are concerned that you may have depression, you should speak to your doctor.

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 (for example thyroid problems) that can mimic symptoms of depression.

They will assess you for depression and can build a mental health treatment plan together with you. This is a plan that maps out your treatment goals and includes the services and resources available to you.

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 a stigma attached to depression or think that depression is a personal weakness rather than a medical condition. Encourage them to speak to their doctor and 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.

How is depression in older people treated?

Your doctor can help build a mental health treatment plan with you. This may include a variety of different treatment strategies and tools. Older age does not make treatments for depression less effective.

Your doctor may recommend physical treatments for depression. Some antidepressant medicines that work for older people can be very effective, especially for people with severe depression. However, they may take longer to work in older people, so you should trial antidepressants for at least 6 to 8 weeks.

Electroconvulsive therapy (ECT) is only used to treat some types of severe depression if medicines have not helped or if your symptoms are severe.

Psychotherapy, such as cognitive behavioural therapy (CBT), is popular, proven and an effective intervention for depression. If you have hearing difficulties, are vison-impaired 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.
• Participate in music or other therapy designed for people with depression.

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

Resources and support

If you or someone close to you is in a crisis, or at immediate risk of harm, call triple zero (000) and ask for an ambulance.

If you need to talk with someone or need support, call Lifeline on 13 11 14. They’re open 24 hours a day, 7 days a week.

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

If you are an older person with 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 treat depression.

Here are some helpful resources to try:

• Black Dog Institute has a fact sheet about depression in older people including signs, types, causes and treatment. They also have a depression help & support page.
• Speak to a trained mental health professional any time of the day or night on Beyond Blue’s helpline — 1300 224 636.
  • 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 24 hours a day, 7 days a week.

Looking for information for sexually and gender-diverse families?

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.

Aboriginal and Torres Strait Islanders

For more information on mental health and wellbeing for Aboriginal and/or Torres Strait Islander people with the Black Dog Institute.

The Beyond Blue has information on how depression affects Aboriginal and/or Torres Strait Islander people.

Other languages

Embrace Mental Health is a project run by Mental Health Australia focused on mental health for people from culturally and linguistically diverse (CALD) backgrounds, providing access to resources, services and information in a culturally accessible format.