Depression in older adults: signs, causes and treatment in the UK

The Royal College of Psychiatrists describes depression as a mental illness that affects the way you think and feel, and says it is quite common and affects people of all ages. The NHS stresses that depression is a real illness with real symptoms, not a sign of weakness or something you can snap out of, and that with the right treatment and support most people can make a full recovery.

In older people depression is easy to overlook. The college points out that the signs may be different: someone may complain about aches and pains, seem more worried or irritable than sad, or gradually stop looking after themselves or their home. Tiredness, poor sleep and loss of appetite can be put down to age or to a physical illness. For this reason, family members, carers and practice staff are often the first to notice that something has changed.

The Royal College of Psychiatrists lists feelings, bodily changes and changes other people might see. Depression can be mild, moderate or severe, and the symptoms vary with the severity.

• Feeling unhappy, hopeless, anxious or worried, or that life is not worth living.

• Struggling to do things, concentrate or remember things, and losing interest in what you once enjoyed.

• Feeling exhausted or restless, sleeping badly or too much, headaches or stomach aches, eating less or more, and losing interest in sex.

• Seeming quieter, more irritable or more isolated and lonely than usual.

• Complaining about aches and pains and neglecting yourself or your home.

The Royal College of Psychiatrists says there are many reasons for depression, such as difficult life experiences, physical health problems and genetic factors, and that some things make older people more likely to be affected. These include living with long-term health conditions, dementia (it estimates around 3 in 10 people with dementia are depressed), Parkinson's disease, loneliness, grief, alcohol use and moving into a care home.

It also describes vascular depression: illnesses that affect the circulation of blood to the brain, such as heart disease, strokes and high blood pressure or cholesterol, can make someone more likely to become depressed. Grief is a normal response to loss, but if feelings of grief stay intense for a long time or get worse, professional help may be needed. Problems with money, housing, care, work and retirement can all affect mental health too, which is why practical support can be part of treatment.

The first step is a GP appointment. The Royal College of Psychiatrists says the GP will ask how you have been feeling and what is going on in your life, and may use a questionnaire to find out whether you have depression and how severe it is. Because other illnesses can look similar, the college says dementia may be confused with anxiety or depression, and that older adult mental health services have the expertise to take this into account.

The NHS adds that it is important to seek help early. The sooner you see a doctor, the sooner you can be on the way to recovery.

The treatment offered depends on how severe the depression is. The NHS says mild depression may be monitored (watchful waiting) alongside exercise and guided self-help, with talking therapies such as CBT also used, while moderate to severe depression often involves talking therapy together with antidepressants. The Royal College of Psychiatrists adds that your GP may refer you to a link worker through social prescribing, and that the NHS five steps (connect, be active, learn, give and pay attention) can help.

For antidepressants, the college says they usually take one or two weeks before you notice benefit, that there is no medical reason why people with dementia cannot take them but they may be less effective, and that people with dementia should not be offered antidepressants for mild to moderate depression unless they have had depression before. It says that if you start to have suicidal feelings or other serious side effects you should stop the antidepressant and get help urgently. In very severe depression, specialist services may be involved and, when other treatments have not worked, ECT may be considered.

The Royal College of Psychiatrists says that if you feel you are in danger you should call 999 or go to A&E. The NHS says that if you have thoughts of suicide or of harming yourself you can call NHS 111 and choose the mental health option for urgent advice. Tell a GP or someone you trust straight away if life feels not worth living.

If you are worried about an older relative who seems to be withdrawing, not eating or talking about not wanting to be here, do not wait for a routine appointment. Ask the GP practice for an urgent review or call 111.

The NHS suggests that people with depression can benefit from more exercise, cutting down on alcohol, giving up smoking and eating healthily, and that reading a self-help book or joining a support group can be worthwhile. Sharing experiences with others in a similar situation can be supportive.

Older adult mental health services take account of frailty, multiple health conditions and bereavement. If you care for someone with depression, the NHS social care and support guide explains options for help with day-to-day living.