Depression in Older Adults Is More Common Than You Think, and Very Treatable

Depression is not a normal part of getting older. Yet many people believe it is. They think feeling sad, tired, or hopeless just comes with age, with retirement, with loss, with health problems. It does not.

About 7 million Americans over 65 have clinical depression. That number does not count the millions more with milder symptoms that still harm their quality of life. And here is the most troubling part: fewer than half of older adults with depression receive treatment.

The reasons for this gap are fixable. Depression in older adults often looks different than in younger people, so it gets missed. Many older adults feel ashamed to talk about mental health. And some doctors spend so little time with patients that they do not ask the right questions.

But when treated, depression in older adults responds well. Very well. Recovery rates are similar to younger adults. The key is recognizing it and getting help.

Why Depression Looks Different After 60

In younger adults, depression usually shows up as sadness. In older adults, it often hides behind other symptoms:

Physical complaints. Older adults with depression are more likely to report headaches, stomach problems, chronic pain, or fatigue than sadness. They visit the doctor for aches and pains, not for feeling down. The physical symptoms are real, but they are driven by the depression.

Irritability and anxiety. Instead of crying or feeling hopeless, an older adult with depression might become restless, short-tempered, or worried about everything. Family members may notice personality changes but not connect them to depression.

Memory problems. Depression can cause difficulty concentrating, forgetfulness, and slow thinking. This is sometimes mistaken for early dementia. Doctors call it “pseudodementia” because it looks like cognitive decline but improves when the depression is treated.

Withdrawal. Losing interest in hobbies, skipping social events, staying in bed longer, stopping exercise. These changes happen gradually, and the person may not realize how much they have pulled back from life.

Loss of appetite or overeating. Significant weight changes in either direction can signal depression.

Risk Factors That Make It More Common

Certain life situations increase the risk of depression in older adults:

Loss of a spouse or close friend. Grief is normal, but when sadness persists beyond a few months and gets worse instead of better, it may have crossed into depression.
Chronic illness. Heart disease, cancer, diabetes, arthritis, and Parkinson’s disease all carry higher rates of depression. Pain itself is a strong risk factor.
Isolation. Living alone, especially with limited mobility or transportation, increases depression risk significantly. A study in The Lancet found that social isolation raised the risk of depression by 50 percent.
Caregiving. Adults caring for a spouse with dementia or chronic illness have depression rates two to three times higher than average.
Medications. Some drugs can cause or worsen depression, including beta-blockers, corticosteroids, benzodiazepines, and certain pain medications. A medication review with your pharmacist can identify potential culprits.
History of depression. If you have had depression before, the risk of recurrence increases with age.

Getting a Diagnosis

The first step is talking to your primary care doctor. A diagnosis does not require fancy tests. It starts with a conversation and a screening questionnaire.

The most commonly used tool is the PHQ-9 (Patient Health Questionnaire). It is nine simple questions about how you have felt over the past two weeks. Your doctor scores the answers to determine the severity.

You can help the process by being honest and specific:

How long have you felt this way?
What does a typical day look like now versus six months ago?
Have you lost interest in things you used to enjoy?
Are you sleeping more or less than usual?
Have you had thoughts about death or harming yourself?

That last question is important. Older adults have the highest suicide rate of any age group in the United States. Men over 85 are at the greatest risk. If you are having thoughts of suicide, call 988 (the Suicide and Crisis Lifeline) or go to your nearest emergency room.

Treatment That Works

Talk Therapy

Psychotherapy, especially cognitive behavioral therapy (CBT), is effective for older adults with depression. CBT helps you identify negative thought patterns and replace them with more realistic ones.

For example, someone who thinks, “I am useless now that I am retired” can learn to reframe that thought: “I have skills and experience that I can use in new ways.”

A typical course of CBT is 12 to 16 weekly sessions. Many therapists offer video appointments, which removes the transportation barrier.

Another effective approach is problem-solving therapy, which focuses on building practical skills to deal with the specific challenges causing stress. For older adults dealing with health problems, housing decisions, or family conflicts, this can be especially helpful.

Medicare Part B covers outpatient mental health services, including therapy, with a 20 percent copay after the deductible.

Medication

Antidepressant medications work well for moderate to severe depression. The most commonly prescribed for older adults are SSRIs (selective serotonin reuptake inhibitors) like sertraline (Zoloft) and escitalopram (Lexapro).

Key things to know about antidepressants for older adults:

They take time. Most people need four to six weeks to feel the full effect. Do not give up after a week.
Start low, go slow. Doctors typically prescribe a lower starting dose for older adults and increase gradually.
Side effects are usually mild and often improve after the first two weeks. Common ones include nausea, headache, and mild sleep changes.
Do not stop suddenly. Tapering off slowly prevents withdrawal symptoms. Always talk to your doctor before stopping.
The combination of medication and therapy works best. Studies consistently show that using both together produces better results than either one alone.

Exercise

Regular physical activity is a proven treatment for mild to moderate depression. A Duke University study found that 30 minutes of brisk walking three times a week was as effective as antidepressant medication for older adults with depression.

Exercise works through several pathways:

It increases serotonin and endorphins (natural mood-boosting chemicals).
It reduces cortisol (the stress hormone).
It improves sleep.
It provides a sense of accomplishment and routine.

You do not need a gym membership. Walking, gardening, swimming, or group exercise classes all count. The social component of group activities adds extra benefit.

Isolation feeds depression, and depression causes isolation. Breaking this cycle is part of treatment.

Practical steps:

Call one person each day. A five-minute phone call reduces loneliness.
Join a group activity. Senior centers, faith communities, volunteer organizations, and library programs all offer regular social contact.
Use technology. Video calls help bridge the distance when family lives far away. Many senior centers and libraries offer free classes on using smartphones and tablets.
Consider a pet. Research shows that pet ownership reduces depression and loneliness. If a dog or cat is too much work, even a fish tank has measurable mood benefits.

When a Loved One May Be Depressed

If you are worried about a parent, spouse, or friend, watch for these changes:

Pulling away from activities they used to enjoy.
Complaining more about physical pain or fatigue.
Seeming more anxious, irritable, or confused.
Neglecting personal care or household tasks.
Expressing hopelessness, guilt, or feeling like a burden.
Changes in eating or sleeping habits.

Starting the conversation can feel awkward, but it matters. Some things you can say:

“I have noticed you seem tired lately. How are you feeling?”
“You have not been to book club in a while. Is everything okay?”
“I read that depression is really common as we get older. Have you ever felt that way?”

Avoid saying things like “cheer up,” “look on the bright side,” or “you have so much to be grateful for.” These feel dismissive, even if well-intentioned.

Where to Get Help

Your primary care doctor is the best starting point. They can screen you, prescribe medication, and refer you to a therapist.
988 Suicide and Crisis Lifeline: Call or text 988. Available 24 hours a day, 7 days a week.
SAMHSA National Helpline: 1-800-662-4357. Free referrals and information.
Psychology Today therapist finder: Search by location, insurance, and specialty at psychologytoday.com.
Your local Area Agency on Aging can connect you with counseling services and support programs. Call the Eldercare Locator at 1-800-677-1116.

The Bottom Line

Depression after 60 is common, but it is not inevitable and it is not permanent. It is a medical condition with effective treatments. The hardest part is often the first step: admitting that something feels wrong and asking for help.

If that step feels too big, start small. Tell one person. Call one number. Make one appointment. That is enough to begin.

Reported by Margaret Chen with additional research from the SeniorDaily editorial team. For corrections or updates, please contact us.

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