It's a mistake to assume depression is an inevitable part of ageing. Depression is never normal, but many older people hide their worries and struggle alone when they feel low.
Dr Rob Hicks last medically reviewed this article in January 2008.
Copied from the BBC Emotional Health site.
Older people are more likely to blame their depression on events or social circumstances. But while the death of a partner or friends, or coping with a chronic illness are important contributory factors, there are real biological changes that account for depression.
Brain-imaging studies have shown that in depression the brain circuits responsible for regulating mood, thinking, sleep, appetite and behaviour all fail to work properly. The chemicals that brain cells use to communicate with each other, called neurotransmitters, become out of balance. This happens in young and old alike and is always abnormal.
Several conditions can lead to depression in the elderly, including heart problems, low thyroid activity (hypothyroidism), vitamin B12 or folic acid deficiency and cancer.
Many drugs also cause, aggravate or trigger depression, including beta-blockers, blood pressure drugs, heart drugs such as digoxin, steroids and sedatives.
Depression often occurs after a stroke, and getting it treated may be critical to restoring normal abilities.
Who's affected by depression?
Depression is much more common in the years after retirement, when people may struggle to adjust to a new role and routine in life.
It's then less likely for the next decade until people are in their mid-70s, when factors such as chronic illness, frequent loss of peers and friends, and increasing restrictions on mobility may be factors.
Depression symptoms in the elderly
Depression has a different pattern of symptoms in older people compared with the young. Anxiety is particularly common, as is the slowing of thought and activity.
Older people also tend to have more bodily symptoms, although it can be difficult to work out whether these are signs of depression or part of the increase in general illness seen with age. Older people are more likely to battle with weakness, for example, as well as headaches, palpitations, loss of interest in sex, abdominal or back pain, shortness of breath and constipation. Imaginary illness and hallucinations are also more common.
Deterioration in mental function can occur with depression at 18 or 88, but young people have greater mental reserves, so these problems often show up more in older people. However, it's important to separate the effects of depression from those of conditions such as Alzheimer's disease.
Treating depression
If you or a friend or relative has problems with bleak moods, get help from your GP as soon as possible or talk to the Samaritans.
Antidepressant drugs can help to restore the balance of neurotransmitters in the brain, while social support and psychotherapy can help to deal with many of the triggers of depression.
Studies have shown that over 80 per cent of people with depression improve when given the appropriate treatment with a combination of medication, psychotherapy and other measures. However, it can take longer for older people to respond to treatment - on average, it takes 12 weeks to achieve remission. In elderly people in particular, research has shown that a combination of psychotherapy and antidepressants is extremely effective in preventing depression from recurring.
Dealing with social isolation is another important part of treating depression. The health benefits of being part of a family or tight community are well known.
Self-help remedies may be worth a try but beware of interactions with prescribed or over-the-counter medicines - St John's wort, for example, is increasingly self-prescribed and may help with mild to moderate depression but it can interfere with other drug treatments.
Always talk to your doctor before trying any complementary remedies.
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