Clinical depression in the elderlyis common. That doesn't mean it's normal. Late-life depressionaffects about 60 million every year aged 65 and older. But only 10% receive treatment for depression. The likely reason is that the elderly often display symptoms of depression differently. Depression in the elderly is also frequently confused with the effects of multiple illnesses and the medicines used to treat them.

How Does Depression In the Elderly Differ From Depression in Younger Adults?

Depression impacts older people differently than younger people. In the elderly, depressionoften occurs with other medical illnesses and disabilities and lasts longer.

 For that reason, it is important to make sure that an elderly person you are concerned about is evaluated and treated, even if the depression is mild.

How Is Insomnia Related to Depression in the Elderly?

Insomnia is usually a symptom of depression. New studies reveal that insomnia is also a risk factor for depression onset and recurrence -- particularly in the elderly.

To treat insomnia, experts sometimes recommend avoiding or minimizing exposure to benzodiazepines (such as Ativan, Klonopin or Xanax) or the newer "hypnotic" drugs (such as Ambienor Lunesta) that, according to the American Geriatric Society, pose an increased risk for impaired alertness, respiratory depression, and falls.

Geriatric experts often favor treating insomnia in the elderly with the hormone melatonin, or a low-dose formulation of the tricyclic antidepressant doxepin (Silenor). Other potentially sedating antidepressants, such as Remeron or trazodone, are also sometimes prescribed for both purposes. The novel sleep aid Belsomra also has demonstrated both efficacy and safety in older adults.  If there's no improvement in the sleep disorder or depression, a psychiatrist or psychopharmacologist may prescribe other medications, psychotherapy, or both.

What Are Risk Factors for Depression In the Elderly?

Factors that increase the risk of depression in the elderly include:

• Being female
• Being single, unmarried, divorced, or widowed
• Lack of a supportive social network
• Stressful life events

Physical conditions like stroke, hypertension, atrial fibrillation, diabetes, cancer, dementia, and chronic pain further increase the risk of depression. Additionally, the following risk factors for depression are often seen in the elderly:

• Certain medicines or combination of medicines
• Damage to body image (from amputation, cancer surgery, or heart attack)
• Family history of major depressive disorder
• Fear of death
• Living alone, social isolation
• Other illnesses
• Past suicide attempt(s)
• Presence of chronic or severe pain
• Previous history of depression
• Recent loss of a loved one
• Substance abuse

Brain scans of people who develop their first depression in old age often reveal spots in the brain that may not be receiving adequate blood flow, believed to result from years of high blood pressure. Chemical changes in these brain cells may enhance the likelihood of depression separate from any life stress.

What Treatments Are Available for Depression In the Elderly?

There are several treatment options available for depression. They include medicine, psychotherapy or counseling, or electroconvulsive therapy or other newer forms of brain stimulation (such as repetitive transcranial magnetic stimulation (rTMS)). Sometimes, a combination of these treatments may be used.

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