Sleeping problems, sadness, forgetfulness, withdrawal from friends - these are behaviors and feelings we often accept in older adults. But for many people age 65 and over, these responses are not a result of the normal aging process, nor are they signs of senility. They are symptoms of a common emotional illness called depression.

If the signs of this illness are recognized and appropriate help is sought, most elderly persons can experience improvement. Accurately diagnosed and treated depression can positively impact every phase of the person's life: memory, interest in activity, and overall physical health.

On the other hand, when depression is not recognized and treated, the consequences can be tragic. Depression may be the cause of up to two-thirds of suicides in older adults. The elderly have the highest suicide rate of any group in America, 50 percent higher than the general population.

Depression is more than an occasional feeling of sadness or a natural, grieving response to loss. It is a group of long-lasting or recurring emotions and behaviors that interfere with a person's normal activities. If you or someone you know has experienced several of the following signs of depression for two weeks or more, professional help should be considered.

Feelings of worthlessness, hopelessness, helplessness

Feelings of inappropriate guilt

Persistent sadness or anxiety

Unexplained crying

Irritability

Withdrawal from formerly pleasurable activities and relationships

Memory loss, confusion, disorientation

Inability to concentrate or make decisions

Lack of attention to physical appearance

Changes in eating habits

Changes in sleeping habits

Decreased energy or fatigue

Thoughts of suicide

Overly concerned with physical problems

The presence of a number of symptoms does not necessarily indicate depression. Only a licensed physician or psychologist can diagnose a person with a psychiatric disorder.

Stress and loss. Aging is a time of change. For some people, the loss of loved ones, health, physical strength, financial stability, retirement, and lessening family responsibilities may be too much to cope with, and depression may result.
Genetics. Some people have a biological vulnerability to depression. While these individuals may live for decades without developing the illness, the many changes of aging may cause the condition to emerge in later years.
Biological factors. Depression can be triggered by a disturbance in the brain biochemicals that regulate mood and activity. These biochemicals are called neurotransmitters: they are substances which carry impulses or messages between nerve cells in the brain. An imbalance in the amount or activity of neurotransmitter can cause major disruptions in thought, emotion, and behavior.
Medical conditions. Certain medical problems, such as hormonal imbalances, nutritional deficiencies, heart disease, and certain cancers physically create the symptoms of depression. Medications for illnesses, particularly high blood pressure or arthritis medications, can cause drug interactions leading to depressive symptoms and mood changes.

Medication. Sometimes used in combination with psychotherapy, medication can correct the biochemical imbalances that cause depressive feelings and behaviors. When carefully prescribed and monitored by a physician, medications can relieve the symptoms of depression in three to six weeks. Over the past twenty years the most frequently used depression medications have been tricyclic antidepressants and, in more severe cases, monomine oxidase (MOA) inhibitors. These medications are not habit-forming and are helpful in reducing the severity, frequency and duration of depressive episodes. Some side effects such as dryness of the mouth, problems urinating, constipation and blurred vision have been associated with their use. Recently, researchers have introduced a new generation of antidepressants that include drugs such as fluoxetime (Prozac), bupropion (Wellburtin), and sertraline (Zoloft).

Depression can lead to thoughts of suicide, a major risk for the elderly who have the highest suicide rate in the country. Each year six thousand older Americans kill themselves. Unlike younger people, the elderly do not attempt suicide impulsively. They plan it carefully over the course of months. This results in a very high rate of actual suicides. By recognizing the following signs that a person is contemplating suicide, family or friends can intervene in time:

Mention of desire to die

Self-denigrating comments such as "my family would be better off without me"

Neglect of self-care, personal hygiene

A sudden interest in putting affairs in order

The giving away of possessions

A sudden interest or disinterest in religion

Encourage or arrange for a diagnostic evaluation with a qualified professional to accurately determine the cause of the symptoms.
Provide support, love, and encouragement to offset the person's loss of self-esteem.
Help ease the sense of isolation and withdrawal by spending time with the person.
Take an active role in helping the person get assistance, You can help schedule appointments or offer transportation to treatment.