Overview, Causes, & Risk Factors

Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings don't go away on their own. They are not necessarily related to a particular life event.

What is going on in the body?

Depression is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved in depression. Nerve impulses cause the release of neurotransmitters from one nerve cell, or neuron, to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression. Some of the neurotransmitters believed to be linked to depression are serotonin, norepinephrine, and dopamine.

The elderly face a lot of situations that can contribute to depression. Many important social support systems are lost. This may be due to the death of a spouse or close friend, retirement, or moving to a new home. The elderly are often also dealing with chronic illnesses. The illnesses can decrease activity, which also leads to depression.

What are the causes and risks of the condition?

There are many theories about what causes depression. Depression may be caused by any of these things:

certain illnesses

certain medicines, including antibiotics

changes in brain chemicals

heredity

hormonal changes

lack of sunlight

major stresses

negative thinking patterns

Risk factors for depression in adults include:

alcohol abuse

drug abuse and addiction

personal history of a suicide attempt

personal or family history of depression

job strain

stress

Older individuals may face additional risk factors because of the aging process or chronic disease. These factors include:

aging changes in the senses

age-related hearing loss

arthritis

cancer

concern about living arrangements

coronary artery disease

death of a spouse or other loved one

financial concerns

heart attack

retirement

some medicines and drug interactions

stroke

In the U.S., depression affects 3% to 5% of people over age 65. When the person has a medical illness, such as coronary artery disease, the rate increases to 40%.

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Symptoms & Signs

What are the signs and symptoms of the condition?

Some symptoms are common in people of all ages with depression. These symptoms include:

appetite problems

decreased energy

difficulty paying attention or making decisions

feeling very sensitive emotionally

feelings of irritability

feelings of sadness, despair, and emptiness

inability to feel pleasure

low self-esteem

loss of motivation and withdrawal from others

pessimism, negativity

sleeping problems

thoughts about suicide and death

Seniors who are depressed may avoid family and friends. They may also show signs of confusion.

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Diagnosis & Tests

How is the condition diagnosed?

Screening tests for depression include:

the Beck Depression Inventory (BDI) 19

the Center for Epidemiologic Studies Depression (CES-D) Scale

A person who screens positively on one of these tests should have a comprehensive evaluation for depression. The evaluation may include a medical history, physical examination, and laboratory tests.

Depression is underdiagnosed in the elderly. The signs of depression may not be as clear as they are in a younger person. Elderly people may tell their healthcare provider about aches and pains or other mood states such as agitation. Symptoms may be confused with other ailments, such as Alzheimer's disease. Seniors may not be aware that they are depressed. They may think they are too old to get help. Some seniors believe that seeking help is a sign of weakness.

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Prevention & Expectations

What can be done to prevent the condition?

Depression may not be preventable. However, these steps may be helpful in preventing it:

avoiding alcohol and illegal drugs

avoiding cigarette smoking

getting prompt treatment for other psychiatric disorders

seeking effective treatment for chronic diseases

talking with a counselor after experiencing a major trauma

Depression can lead to suicide. It is important to recognize and treat the condition early. Individuals should be encouraged to talk to someone if they are concerned about depression. There are many people to whom they can talk, including:

a clergy member

a counselor at a senior center

a family doctor

a professional at a mental health center

a psychologist

a trusted family member

What are the long-term effects of the condition?

With good treatment, many people recover from depression. Some people experience it only once in their lives. Others have periodic bouts of depression.

If depression is not effectively treated, a person can experience serious difficulties in every area of life. Depression often hurts relationships. It also impairs work and volunteer participation. In some cases, it leads to suicide.

People with depression are at higher risk for many chronic diseases and conditions, including:

coronary artery disease

heart attack

personality disorders

stroke

Seniors who are depressed are more likely to report poor health status and low quality of life. They are also more likely to die from health problems, such as heart attack.

What are the risks to others?

Depression is not contagious.

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Treatment & Monitoring

What are the treatments for the condition?

The two most common ways of treating depression are with antidepressant medicines and psychotherapy. Often a combination is used. Occasionally, a person must be hospitalized for intense treatment or for his or her own safety.

Antidepressant medicines are effective in:

increasing the person's ability to function in daily life

lowering the risk of suicide

making the person feel better

The following types of medicines are used to treat depression:

monoamine oxidase inhibitors (MAOIs), such as phenelzine sulfate and tranylcypromine sulfate

other antidepressants, such as nefazodone and venlafaxine

selective serotonin reuptake inhibitors (SSRIs), including paroxetine HCl and fluoxetine HCl

tetracyclic antidepressants, such as maprotiline HCl and mirtazapine

tricyclic antidepressants (TCAs), including amitripyline HCl and desipramine HCl

Psychotherapy can help people:

cope better with having depression

feel less alone

improve relations with family, friends, and coworkers

learn about depression and how it affects them

learn to recognize and avoid situations that can bring on a depressive episode

learn to view the world and others more positively and more realistically

positively address problems that they may be facing

stop episodes of depression early by recognizing warning signs and symptoms

What are the side effects of the treatments?

Antidepressants may cause mild and usually temporary side effects in some people. The most common side effects are:

dry mouth

agitation

constipation

dizziness

drowsiness

nausea

What happens after treatment for the condition?

An individual can help prevent relapses by living a healthy lifestyle. Some important parts of the healthy lifestyle include:

avoiding alcohol, illegal drugs, and smoking

doing regular exercise

eating a balanced diet, following the food guide pyramid

finding a support system for dealing with depression

finding ways to manage stress

getting enough rest

How is the condition monitored?

Once a person has an episode of depression, he or she is at higher risk for further episodes. Any new or worsening symptoms should be reported to the healthcare provider. The provider may recommend regular visits to monitor symptoms. The provider may also order blood tests to monitor the levels of medicines.

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