This information is written for people over 65 who have depression. We hope it will also be helpful for relatives, friends and carers.
- the symptoms of depression
- how it can be helped
- some suggestions for further reading.
The content in this leaflet is provided for general information only. It is not intended to, and does not, mount to advice which you should rely on. It is not in any way an alternative to specific advice.
You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this leaflet.
If you have questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay.
If you think you are experiencing any medical condition you should seek immediate medical attention from a doctor or other professional healthcare provider.
No representation, warranties or guarantees
- stopping work
- having less money
- health problems
- the death of a partner or friends.
Most older people cope well in spite of these difficulties. However, depression can affect 1 in 5 older people living in the community, and 2 in 5 living in care homes.
If you do get depressed, there is help available for you which works, as there is for younger people.
Feeling low or sad is not the only sign of depression.
- Lose interest in life - you can't enjoy the things you usually do.
- Feel tired for no reason. You just don't feel like doing anything. Simple things take a big effort.
- Lose your appetite - and weight.
- Feel restless - and find it hard to relax.
- Worry more than is usual for you.
- Want to avoid people.
- Feel snappy or irritable with people.
- Sleep badly. You may wake an hour or two earlier than usual and find that you can't get back to sleep.
- Lose confidence in yourself.
- Feel useless or a burden to others.
- Notice that you can't concentrate properly.
- Feel panicky.
- Lose your sexual feelings.
- Feel bad or guilty. You dwell on things from the past and may get things out of proportion.
- Think about suicide - at some point most people with severe depression will feel like ending it all.
Physical symptoms and depression
Confusion and memory problems
A new sense of loneliness
How do you know when it's time to get help?
- are worse than you would expect
- have gone on for several weeks
- interfere with your life
- mean that you can't face being with other people
- make you feel that life is not worth living
- worry you are causing concern to friends or family
- include thoughts of harming or killing yourself.
What should you do?
You are not wasting your GP's time by asking for help. If you can't get out, ask your GP to see you at home. You may find it helpful to take a friend or relative with you when you see your GP.
I don't want to bother the doctor - depression isn't a real illness
You may have been brought up not to bother the doctor unless you have a physical complaint.
Sometimes the first sign of depression can be a constant worry about having a physical illness, even when your doctor can't find anything wrong with you.
If he or she tells you that you are depressed, it may feel as though you are not being taken seriously. This isn't the case. Depression can be treated just like any illness.
We may start to blame ourselves for things that we are not responsible for.
Painful eventsDepression can come out of the blue. More often it is triggered by something, like the death of a partner or close friend.
Some of us are just more likely to get depressed when faced by a difficult or painful situation - it's our temperament. Women seem to be more likely to get depressed than men, but men may just find it harder to talk about.
Past depressionYou are more likely to get depression if you have had it before.
Any physical illness can trigger depressionThis can be sudden, like a stroke, or long and disabling, like Parkinson's disease.
It may be several illnesses which have taken their toll over the years. Although this may make the depression more 'understandable', it doesn't mean that it can't be helped. This type of depression often responds very well to treatment.
MedicinesDepression can be caused by some medications. You can ask your doctor or pharmacist about this.
- Ask for help: It's the same at any age, you don't have to put up with being depressed. Tell your GP how you feel.
- Keep active: It can be hard to get our regularly because of physical problems, but it's worth doing. We know that if you keep up some regular physical activity, you tend to feel better. And if you are alone at home, you are more likely to brood on things, which can make you feel even worse.
- Stay connected: It helps to keep your mood up by:
- keeping up with hobbies and interests
- staying in touch with friends and family
- visiting your local library or local lunch clubs and day centres.
- Try to eat properly: If you lose your appetite, it's easy to lose weight and run short of important vitamins and minerals. Older bodies cannot adjust as well as younger ones - so this can really affect your health. Beware of stocking up on chocolate and biscuits - these are quick and easy to eat, but they don't have the vitamins and minerals to keep you feeling well.
- Remind yourself that depression is an illness - not a sign of weakness. You are not being lazy or letting other people down.
- Tell someone if you feel so low that you have thoughts of taking your own life.
- Don't keep your feelings to yourself. Talking to somebody does help.
- Watch your drinking. Alcohol can make depression worse. It can also react with any tablets you are taking.
- Try not to panic about not sleeping properly. It will get better when the depression lifts.
- Try not to change the tablets you are on without discussing it with your doctor. If your tablets have side-effects, tell your doctor or nurse.
- Be kind to yourself - you may need to change your routine while you are unwell.
- Try not to think that depression causes dementia. It doesn't.
It can help to talk to a good listener. This could be a friend, a relative, a volunteer or a professional. If this is not enough, professionals can offer special ways of talking which include:
Are there problems with talking treatments?
If you are depressed and have poor sleep, poor appetite and loss of weight (or over-eating and weight gain), or the depression has gone on for a long time, your doctor will often suggest an antidepressant.
About 50-60% of people who take these tablets will find they help. There are several types of antidepressant now available, so it should be possible to find one to suit you.
Do antidepressants have side-effects?
To help with this, your doctor or chemist can give you a special box, or blister pack. This has all the tablets set out in separate compartments for each time and day of the week.
St John's Wort
It can be harmful if taken with some other medications - so, if you are taking other medication, ask your GP about this.
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT for short) can be used:
- In severe depression, if the person's life is at risk and they need urgent treatment
- In moderate or severe depression, when no other treatment has helped.
If so, a social worker can help you to get advice on financial or practical support - or even moving house. But do be careful, it is easy to make a bad decision about moving when you are depressed.
It is usually best to put off big decisions like this until you are feeling better.
There are lunch clubs, day centres and support groups where you can go. It's really important to talk with or just to meet other people. It will help.
Your GP is more likely to recommend antidepressants if your depression is severe, or has gone on for a long time.
You can have both at the same time. Your GP will be able to give you advice. It may also help to talk over the options with your family or a close friend.
The simple steps outlined in this leaflet may be enough to help you feel well again.
If the depression is so bad that you are not eating or drinking enough, you can become dangerously ill. It may give you thoughts of suicide.
That does not mean that people think you are 'mad'. Your GP may need a second opinion or advice about the best treatment for you.
They usually work as part of a specialist mental health team, so you will usually see a nurse or a social worker first.
If so you can ask a friend, neighbour or relative to be present with you. It can also help to write down your ideas before the interview.
Going into hospital
If you are very unwell - perhaps unable to eat or drink, or have tried to kill yourself - you may need the safety of a hospital.
Only a small number of people with depression become this unwell.
- You may be the first person to notice the depression. Encourage them to get help. Tell them that depression is quite common, it can be treated and that they will get better. They may need to be reassured that they are not "going mad". You can suggest that they see their GP - and offer to go with them.
- People with depression get tired easily. Try to offer some practical help, like shopping or cleaning for them. They may need reminding to eat properly.
- Don't force them to talk. Just being with someone is often helpful.
- Don't push them into doing things. It can help to get out and do some gentle physical activity - but it may not help if you have to nag them to do it. In fact, people will often dig their heels in if they feel they are being put under too much pressure. It may be more acceptable for you to offer to go with them to something they want to do - a lunch club, a day centre, library or interest group.
- Be patient. Depression can make someone constantly ask for reassurance or become convinced that they've got something physically wrong with them. It's often because they are frightened or don't understand what is happening to them. Reassure them as much as you can and try to spend time listening. You may need to reassure them that they are not "losing their mind".
- Don't be embarrassed to ask if they have felt suicidal. Most people who feel like this are just relieved when someone asks about it. Talking about it will help.
- You can become exhausted while caring for someone with depression - and then it is important to ask for help yourself. The specialist mental health team can give you a break by arranging for them to go to a day centre or day hospital. They are also there for you to talk to.
- Finally, be cautious of making decisions about housing or accommodation when someone is depressed. They may put pressure on you and say that how they feel is all to do with where they live. But things are not usually that simple. People who move when they are depressed may regret it once they are better. Remember that social services may be able to help with self-care, meals and finances.
- Don't judge and do be supportive - depression is an illness which can be helped.
Reading Well Agency: Books on Prescription
The scheme is endorsed by health professionals, including the Royal College of Psychiatrists, and is supported by public libraries.
Organisations which can help
Tel: 0800 169 6565.
Helpline: 1890 303 302
- Wilson K, Mottram P, Sivanranthan A, Nightingale A. Antidepressants versus placebo for the depressed elderly (Cochrane Review). In: The Cochrane Library, Issue 4, 2001.
- Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder. Mather AS et al. (2002) British Journal of Psychiatry, 180,411-415.
Cross-cultural comparison of depressive symptoms in Europe does not support stereotypes of ageing. Copeland JR et al. (1999) British Journal of Psychiatry, 174,322-329.
- National Institute for Health & Care Excellence: Depression: the treatment and management of depression in adults (update) (2009)
- National Institute for Health & Care Excellence: TA59: Electroconvulsive therapy guidance (2010)
- The Fundamental Facts ISBN:978-1-903645-932. The Mental Health Foundation.
This leaflet had been produced by the Royal College of Psychiatrists' Public Education Editorial Board.
Series editor: Dr Philip Timms
Expert review: Dr Martin Briscoe
Service user and carer input: members of Depression Alliance
© September 2014 Royal College of Psychiatrists