Older Adults: Depression and Suicide Facts

Last Updated: Dec. 1, 2003

Depression, one of the most common conditions associated with suicide in older adults, is a widely underrecognized and undertreated medical illness. In fact, several studies have found that many older adults who die by suicide – up to 75% – have visited a primary care physician within a month of their suicide. These findings point to the urgency of improving detection and treatment of depression as a means of reducing suicide risk among older persons.

Of the nearly 35 million Americans age 65 and older, an estimated 2 million have a depressive illness (major depressive disorder, dysthymic disorder, or bipolar disorder) and another 5 million may have “subsyndromal depression,” or depressive symptoms that fall short of meeting full diagnostic criteria for a disorder.

Subsyndromal depression is especially common among older persons and is associated with an increased risk of developing major depression. In any of these forms, however, depressive symptoms are not a normal part of aging. In contrast to the normal emotional experiences of sadness, grief, loss, or passing mood states, they tend to be persistent and to interfere significantly with an individual’s ability to function.

Depression often co-occurs with other serious illnesses such as heart disease, stroke, diabetes, cancer, and Parkinson’s disease.

Because many older adults face these illnesses as well as various social and economic difficulties, health care professionals may mistakenly conclude that depression is a normal consequence of these problems – an attitude often shared by patients themselves. Both doctors and patients may have difficulty identifying the signs of depression.

Research and treatment
Research has revealed varying patterns of clinical and biological features among older adults with depression. As compared to older persons whose depression began earlier in life, those whose depression first appears in late life are likely to have a more chronic course of illness. In addition, there is growing evidence that depression beginning in late life is associated with vascular changes in the brain.

Both antidepressant medications and short-term psychotherapies are effective treatments for late-life depression. Existing antidepressants are known to influence the functioning of certain neurotransmitters in the brain. The newer medications, chiefly the selective serotonin reuptake inhibitors (SSRIs), are generally preferred over the older medications, including tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), because they have fewer and less severe potential side effects. Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another.

Research has shown that certain types of short-term psychotherapy, particularly cognitive-behavioral therapy and interpersonal therapy, are effective treatments for late-life depression. In addition, psychotherapy alone has been shown to prolong periods of good health free from depression.

Combining psychotherapy with antidepressant medication, however, appears to provide maximum benefit. In one study, approximately 80% of older adults with depression recovered with combination treatment. The combination treatment was also found to be more effective than either treatment alone in reducing recurrences of depression.

Source: National Institute of Mental Health (NIMH)

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