Depression in Older Men

Depression in Older Men

Depression can strike anyone regardless of age, ethnic background, socioeconomic status, or gender; however, large-scale research studies have found that depression is about twice as common in women as in men. In the United States, researchers estimate that in any given one-year period, depressive illnesses affect 8.5 percent of women and nearly 5 percent of men. But important questions remain to be answered about the causes underlying this gender difference. For example, is depression truly less common among men, or are men just less likely than women to recognize, acknowledge, and seek help for depression?

In focus groups conducted by the National Institute of Mental Health (NIMH) to assess depression awareness, men described their own symptoms of depression without realizing that they were depressed. Notably, many were unaware that "physical" symptoms, such as headaches, digestive disorders, and chronic pain, can be associated with depression. In addition, they expressed concern about seeing a mental health professional or going to a mental health clinic, thinking that people would find out and that this might have a negative impact on their job security, promotion potential, or health insurance benefits. They feared that being labeled with a diagnosis of mental illness would cost them the respect of their family and friends, or their standing in the community.

Men must cope with several kinds of stress as they age. If they have been the primary wage earners for their families and have identified heavily with their jobs, they may feel stress upon retirement-loss of an important role, loss of self-esteem-that can lead to depression. Similarly, the loss of friends and family and the onset of other health problems can trigger depression. Nevertheless, most elderly people feel satisfied with their lives, and it is not "normal" for older adults to feel depressed.  Depression is an illness that can be effectively treated, thereby decreasing unnecessary suffering, improving the chances for recovery from other illnesses, and prolonging productive life.

However, health care professionals may miss depressive symptoms in older patients, who are often reluctant to discuss feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss, and who may complain primarily of physical symptoms. Also, it may be difficult to discern a co-occurring depressive disorder in patients who present with other illnesses, such as heart disease, stroke, or cancer, which in themselves may cause depressive symptoms, or which may be treated with medications that have side effects resembling depression. If a depressive illness is diagnosed, treatment with appropriate medication and/or brief psychotherapy can help older adults manage both diseases, thus enhancing survival and quality of life.

The importance of identifying and treating depression in older adults is stressed by the statistics on suicide among the elderly. There is a common perception that suicide rates are highest among the young; however, it is the elderly, particularly older white males that have the highest rates. Over 70 percent of older suicide victims have been to their primary care physician within the month of their death, many with a depressive illness that was not detected. This has led to research efforts to determine how to best improve physicians' abilities to detect and treat depression in older adults.

Approximately 80 percent of older adults with depression improve when they receive treatment with antidepressant medication, psychotherapy, or a combination of both. In addition, research has shown that a combination of psychotherapy and antidepressant medication is highly effective for reducing recurrences of depression among older adults. Psychotherapy alone has been shown to prolong periods of good health free from depression, and is particularly useful for older patients who cannot or will not take medication. Improved recognition and treatment of depression in late life will make those years more enjoyable and fulfilling for the depressed elderly person, the family, and caregivers.