Why Depression Is Underdiagnosed in Older Adults

Two months ago, I started working for a health insurance company. One of my recent (and most time consuming) tasks has been to read through all of the comment cards submitted to our Medicare magazine.

One of the questions on the card was “What health topics would you like to read about?” Looking through the cards, one of the most common answers was “Depression and mental illness in older adults.”

I talk a lot about mental illness and suicide in teenagers and young adults. But, the truth is, suicide rates increase during the life course, according to the US National Library of Medicine, and depression is often underdiagnosed and undertreated in adults age 65 or older.

Some risk factors for depression in older adults include:

• History of depression
• Chronic or severe pain
• Vascular illness
• Being a widow/having someone you love die
• Lack of a supportive social network
• Living alone
• Reduced independence
• Damage to body image
• Fear of death
• Side effects of meds

It’s true what actress Bette Davis once said: “Getting old ain’t for sissies.” Aging isn’t easy. It’s rough. Obviously, the older you are, the more you have gone through in your life — the joyous, the tragic and everything in-between. And the older you are, the more wear and tear that’s been put on your body (I feel my age every time I wake up in the morning after a night of drinking. And then I think to myself, “You’re not 21 anymore!”).

So, if depression is more likely as we get older, then why is depression underdiagnosed in this demographic? Twenty-five percent of seniors experience some form of mental illness, according to the National Council on Aging, yet two-thirds do not receive the treatment they need.

One reason is because the baby boomer generation is less likely to believe they need mental health care and so they are less likely to bring it up. “Older people grew up in an era when talking about a psychiatric issue was certainly frowned upon, so there may be a generational issue,” Dr. Philip R. Muskin, psychiatry professor at Columbia University Medical Center, told U.S. News. During the years following WWII, learning disabilities, autism, ADHD, anorexia, etc. just weren’t talked about or diagnosed. Just in the last decade or so, we’ve made great strides in raising awareness and changing the conversation surrounding mental health.

Sure, you may make fun of us millennials for a lot of things. But, you have to admit, there is one thing we do right. We’re much more likely to seek help if we have a mental illness – because we’ve received a lot more social support than those in previous generations.

Another reason why depression is underdiagnosed in seniors is because the signs of depression may be misinterpreted. Difficulty sleeping, loss of appetite, lack of concentration and forgetfulness are all signs of depression. But these signs could also be mistaken for other health conditions.

Dr. Muskin admitted to U.S. News, “If a young person is not sleeping, has no appetite, no energy, the first thing I think of is depression. An 85-year-old with those same things, depression is not going to be high on my list. … Too often, changes in mood, interest, activity level and personality are incorrectly attributed to aging, and the possibility of a mental illness is not considered.”

So, knowing this, what do you do if you’re over 65 and think you’re depressed?

1. Realize that depression is not a normal part of aging!

If, for the last two weeks or more, you have been feeling constantly sad, lost interest in things you once enjoyed, are having trouble sleeping, have changes in appetite, and/or have thoughts of suicide, you may think, “Oh, this is just happening because I’m getting older.” No! These things are not normal, and you shouldn’t be feeling this way!

2. Recognize that depression is a disease like any other.

If you felt a sharp pain in your chest, you would go to the doctor. If you felt a lump on your body, you would go to the doctor. If you feel symptoms of depression, you should go to the doctor! Depression is an illness that you can’t control. It’s not your fault, it’s not a weakness and treatment is available that can help you feel better.

3. Know the symptoms.

Symptoms of depression in older adults may be different than the symptoms in younger people. You may think, because you don’t feel sad, that means you aren’t depressed, right? According to helpguide.org, many depressed seniors say they don’t feel sad at all. Depression doesn’t just mean being sad. You may have other symptoms, such as low motivation, lack of energy, unexplained aches, neglecting self-care and memory problems.

4. Make an appointment to see your doctor.

With a physical exam and/or a lab test, a doctor can determine if the symptoms of depression are caused by a physical medical condition or are a side effect of medication. If the depression cannot be attributed to a physical cause, then the next step is a psychological evaluation.

According to the National Institute on Aging, “Treatment choices differ for each person, and sometimes multiple treatments must be tried to find one that works. It is important to keep trying until you find something that works for you. … With treatment, most people will begin to feel better. Expect your mood to improve slowly. Feeling better takes time, but it can happen.”