It Doesn’t Always Look Like Sadness
When most people think of depression, they picture someone visibly sad, crying, withdrawn. In older adults, depression often wears a different disguise. Your mom might not say she’s depressed. She might say her back hurts more than usual, she’s not hungry, or she just doesn’t feel like going to her bridge club anymore. And because these complaints sound “normal” for aging, everyone — including her doctor — writes them off.
Depression affects about 7% of adults over 60 and up to 13% of those in nursing homes. But it’s estimated that only about a third of depressed older adults are identified and treated. That means millions of elderly parents are suffering from something treatable while everyone around them assumes it’s “just getting old.”
Warning Signs That Aren’t Obvious
Physical complaints with no clear cause. Headaches, digestive problems, body aches that don’t respond to treatment. Older adults are much more likely to express depression through physical symptoms than emotional ones. If your parent has seen multiple specialists for vague complaints without finding an answer, depression should be on the list.
Losing interest in things they used to enjoy. Your dad used to tinker in his workshop every afternoon. Now it’s collecting dust. Your mom loved her garden. Now she doesn’t bother. This “anhedonia” (inability to feel pleasure) is one of the two core symptoms of depression, and in older adults, it’s often more prominent than sadness itself.
Irritability or agitation. Depression in the elderly frequently manifests as crankiness, frustration, or short-temperedness rather than tearfulness. If your parent has become notably more irritable, argumentative, or easily agitated, don’t assume it’s just them being difficult.
Social withdrawal. Declining invitations, skipping church, not calling friends back. Isolation both causes and results from depression, creating a vicious cycle.
Cognitive changes. Difficulty concentrating, slowed thinking, memory complaints. Depression in older adults can look so much like early dementia that clinicians coined the term “pseudodementia.” The crucial difference: depression-related cognitive problems improve with depression treatment. Dementia doesn’t.
Changes in sleep. Sleeping much more than usual or waking up very early and not being able to fall back asleep. Early morning awakening is particularly characteristic of depression in older adults.
Weight changes. Significant weight loss from not eating, or weight gain from comfort eating. Unintentional weight loss in an elderly person should always trigger medical evaluation.
Talking about being a burden. “You’d all be better off without me.” “I’m just taking up space.” These statements may sound like self-deprecation, but in an elderly person, they can signal both depression and suicidal ideation. Take them seriously.
Why Depression Gets Missed in Older Adults
Multiple factors conspire to keep elderly depression invisible:
- Older adults don’t talk about emotions the same way. The current generation of elderly grew up in an era when mental health was stigmatized. They’re more likely to describe physical symptoms than emotional distress.
- Symptoms overlap with medical conditions. Fatigue, pain, sleep changes, appetite loss — these are common in many chronic diseases that affect older adults. The depression gets attributed to the diabetes, heart disease, or arthritis.
- Doctors don’t screen for it. Primary care visits for elderly patients focus on managing chronic conditions. Mental health screening often gets skipped, especially when the patient is presenting with physical complaints.
- Families normalize it. “Well, she’s 78 and lives alone. Of course she’s not herself.” Aging involves losses, but depression isn’t an inevitable part of getting old. It’s a medical condition.
How to Start the Conversation
This might be the hardest part. Your parent may resist the idea of depression or see it as weakness. Some approaches that work better than others:
- Don’t lead with “depression.” Try: “I’ve noticed you haven’t been sleeping well and you don’t seem to enjoy your garden anymore. I’m wondering if something’s going on that your doctor should know about.”
- Frame it as a medical issue. “Depression can happen when brain chemistry changes, just like high blood pressure happens when blood vessels change. It’s not about being weak.”
- Connect it to their physical health. “Sometimes mood changes can make your heart condition worse. Treating depression actually helps your other health problems too.”
- Offer to go with them. “How about I come to your next doctor’s appointment? We can bring up how you’ve been feeling together.”
Treatment Works Well in Older Adults
This needs to be emphasized because many people — including some doctors — assume elderly depression is less treatable. It’s not. Treatment response rates in older adults are comparable to younger populations.
SSRIs are generally first-line for elderly depression. Sertraline and escitalopram are commonly used due to favorable side effect profiles in older adults. Psychotherapy, particularly Problem-Solving Therapy and Behavioral Activation, is also highly effective. Exercise (even walking) has evidence comparable to mild antidepressant benefit.
If depression co-occurs with anxiety (which it often does), the DASS-21 assessment can help map both simultaneously for a more complete picture.
Frequently Asked Questions
Is depression normal in old age?
No. Common, but not normal. Depression is a medical condition at any age. While older adults face legitimate losses (health, independence, loved ones), clinical depression goes beyond normal grief and sadness. It’s treatable and should be treated.
Can dementia and depression coexist?
Yes, frequently. Up to 40% of people with dementia also have depression. And depression is a risk factor for developing dementia later. When both are present, treating the depression can improve cognitive function, daily functioning, and quality of life even if the underlying dementia persists.
What if my parent refuses help?
Keep the door open without pressuring. Mention it gently and regularly. Engage their primary care doctor — sometimes hearing it from a physician carries more weight. Focus on specific changes you’ve observed rather than diagnostic labels. And make sure you’re taking care of your own mental health through this process. Caregiver burnout is real.
