Depression

745 Fifth Avenue, Suite 900

New York, NY 10151
www.dana.org

601 E Street, NW
Washington, DC 20049
www.aarp.org/nrta
D17455(1003)

W
NRTA: AARPs Educator Community
NRTA (www.aarp.org/nrta) is AARPs educator community. Consistent with AARPs
mission, NRTA is dedicated to enhancing the quality of life for all as we age, specifically
through a focus on education and learning. NRTA works for positive social change in the
field of education and provides members with valuable information, advocacy, and service
initiatives related to learning and education. NRTA provides national leadership through its
network of affiliated retired educators associations in 50 states and 2,700 communities and
through its national office at the AARP headquarters in Washington, D.C. The partnership
with the Dana Alliance for Brain Initiatives, and the Staying Sharp initiative, recognizes and
explores the intimate connection between the brain, human behavior, and the ability to
continue to learn throughout life.

The Dana Alliance for Brain Initiatives

The Dana Alliance for Brain Initiatives (www.dana.org) is a nonprofit organization of more
than 200 leading neuroscientists, including ten Nobel laureates. The Dana Alliance is
committed to advancing public awareness about the progress and benefits of brain research
and to disseminating information on the brain in an understandable and accessible fashion.
Supported entirely by the Dana Foundation, the Dana Alliance does not fund research or
make grants.
The Dana Foundation is a private philanthropic organization with principal interests in
science, health, and education. The Foundations current areas of emphasis are in
immunology and neuroscience research, and in K12 education, particularly the training
of arts educators.

e all feel blue occasionally, or are faced with

events that deeply sadden us. Few people have
not felt the pain of a job loss, a strained relationship,
or the death of a loved one. Heartache and grief are
natural parts of life, but sadness that persists and
interferes with regular activities could be depression.
Depression is a serious medical disorder with biological causes, just as
high blood pressure or diabetes is. It can be treated effectively in most
people. Despite this, many people mistakenly believe that depression is
normal for older people, or that little can be done about it. We may
think it is a character flaw, a sign of weakness, or something that we
should be able to snap out of.
Its time to dispel these and other myths about depression. While it is
true that depression is more common in older people than in the
general population, it is not an inevitable part of aging. Nor is it
something that we can control at will, or something of which to be
ashamed. These persistent biases contribute to the underrecognition
and undertreatment of depression, as well as other mental disorders.
Some studies show that less than one-fourth of people with depression
are accurately diagnosed and adequately treated. The problem may be
even worse among the elderly, often because the recognition of
depression is complicated by the coexistence of other medical
conditions. Left untreated, depression wreaks havoc on a persons
quality of life, may worsen symptoms of other diseases, and even can
be fatal. People who have suffered a stroke or heart attack, for example,
are more likely to die if they have depression. Moreover, people with
depression are more likely to attempt suicide, and suicide is more
common in the elderly than in any other age group.

2001, 2003 AARP Foundation and the Dana Alliance for Brain Initiatives.
All rights reserved. Reprinting with permission only.
DEPRESSION

Symptoms of Depression

Causes of Depression

Depression is more than feeling blue. Deep sadness is often

compounded by other emotional, mental, and physical symptoms,
including those noted below. Symptoms may range from mild to
severe, and may wax and wane over time. When symptoms interfere
with normal day-to-day activities, depression may be the cause.
Prolonged sadness or unexplained crying spells
Significant changes in appetite and sleep patterns
Irritability, anger, worry, agitation, anxiety, pessimism, indifference
Loss of energy and enthusiasm, persistent sluggishness
Feelings of guilt, worthlessness, hopelessness, helplessness
Inability to concentrate or make decisions
Loss of enjoyment from once-pleasurable activities
Withdrawal from social contacts, isolation
Unexplained aches and pains
Recurring thoughts of death or suicide
Memory loss

Depression is a brain disorder characterized by changes in certain brain

chemicals called neurotransmitters. According to the National Institute
of Mental Health, recent brain-imaging research has shown that, in
depression, some of the brain circuits responsible for mood, sleep,
appetite, thinking, and behavior malfunction, and the regulation of critical
neurotransmitters is impaired. Scientists are still trying to determine what
causes these chemical imbalances; many experts believe a combination of
genetic, psychological, and environmental factors are involved.

Source: National Institute of Mental Health

Percentage of persons age 65 or older with severe

depressive symptoms, by age group and sex, 1998
Adapted from: Health and Retirement Study

25%

Men
Women

The precise contribution of inherited genes is unclear. Some types of

depression run in families, suggesting that there is a genetic basis for
the disorder. However, many people with depression have no family
history, and not everyone with a family history of depression develops
the condition.
Environmental factors that might trigger depression include grief from
the loss of a loved one, serious financial difficulties, or problems in
relationships all factors that may put an individual under serious
stress. (See Whats New in Brain Research.) Other factors that are
linked to depression include low self-esteem, consistent pessimism, and
a tendency to be overwhelmed by stress, attributes that may in reality
be an early form of depression or may predispose a person to
depression.

20%
15%
10%
5%
0%

6569

7074

7579

8084

85+

Age
Note: Definition of severe depressive symptoms: Four or more symptoms out of a list of
eight depressive symptoms from an abbreviated version of the Center of Epidemiologic
Studies Depression Scale.

DEPRESSION

DEPRESSION

Whats New in Brain Research

Some Tips For Managing Stress
Mind the basics: eat regular, healthy meals, get enough
sleep, and regularly engage in physical activity, such as
walking, swimming, biking, etc.
If something is stressing you, take some kind of action that
affords you a modicum of control over the situation, even if
only in a small way.
Recognize that there are some things you cannot control,
and focus your attention on those that you can.
Use relaxation strategies such as deep breathing, meditating,
or visualizing a calm, peaceful space.
Put things in perspective: consider what is most valuable to
you, set realistic goals, develop a roadmap for achieving
them, and take incremental actions toward your goal.
Changes can be stressful; try to see them as opportunities
rather than threats.
Develop a positive sense of humor, and put some fun back
into your life by doing something you really enjoy.
Carve out personal time even if its 15 minutes a day
or an hour a week that you devote solely to restful,
rejuvenating activities.

In addition, many chronic medical conditions, such as stroke, heart

disease, or cancer, may set off changes in the brain that make a person
more susceptible to depression. (See Depression and Other Medical
Illnesses.) People over 65 are more likely to have one of these
conditions, which may contribute to the higher incidence of
depression in older people.

Recent findings in brain research have provided intriguing

new evidence for a link between stressful life events
such as the loss of a loved one or prolonged health
problems and the onset of depression. In fact, in older
persons, stress is thought to play a bigger role in triggering
depression than in other groups, according to the
American Association of Geriatric Psychiatry (AAGP).
Some studies have
found that, in many
depressed people, the
brain system that
regulates the bodys
response to stress is
overactive. When faced
with a stressor, the
brain releases a flood of
powerful stress
hormones, which help
the body respond to the
stressful event. If this
system is persistently
activated, as it may be
when stress is chronic, it may begin to malfunction and
fail to shut off the cascade of hormones. Stress hormones
are known to cause damage to nerve cells in certain brain
regions, and some scientists believe that a prolonged
bath of these hormones may somehow set off brain
changes that lead to depression. While brain researchers
finish piecing together the puzzling link between stress
and depression, one thing seems clear: managing stress
throughout life may help prevent damage to the stressresponse circuit in the brain.

DEPRESSION

DEPRESSION

Getting Help for Depression

The negative thoughts and feelings associated with a depressive disorder,
such as exhaustion, worthlessness, helplessness, and hopelessness, can
work against getting help. Its important to recognize that these are part
of the condition, and, if properly treated, will improve.
If you think you may be
depressed, talk to your doctor
about your concerns. Ask to
be screened for depression,
and discuss possible treatment
options. Sometimes, what
may appear to be symptoms
of depression may actually be
side effects of medications, or
may be caused by another
illness. Your doctor will want
to rule out other possible causes of symptoms, so be sure to
communicate what medications youre taking, what other conditions
you have, and what is going on in your life that could be affecting
your mood.
To diagnose depression, your doctor should perform:
A physical examination and laboratory tests to rule out other
problems
An interview to elicit details about symptoms, including:
When they started
How long they have lasted
How severe they are
Whether you have had them before (If so, when? Were they
treated? With what?)
A complete personal and family medical history

A mental status examination, to identify any effects on speech,

memory, or thought patterns
Source: National Institute of Mental Health

Keep in mind that depression often is not diagnosed by primary care

physicians, especially in older persons, so you may need to seek the
help of a specialist. For example, a geriatric psychiatrist is a doctor who
is specially trained to recognize and treat mental illnesses in older
people.

Types of Depressive Disorders

Recent brain research suggests that depression may be a chronic
condition whose symptoms occur to varying degrees throughout life in
susceptible persons. Studies have shown, for example, that people who
have even one depressive episode in their life are at increased risk for
developing major depression. Depression in later life may in fact be a
recurrence of an earlier episode.
A diagnosis of depression might specify one of two primary types:
unipolar depression or bipolar disorder.
Unipolar depression
Can be further differentiated as either major depression or dysthymia:
Major depression may be diagnosed if five or more depressive
symptoms (see Symptoms of Depression) are experienced nearly
every day in a two-week period, especially if the symptoms interfere
with daily life.
Dysthymia - This is a less severe but no less important form of
depression, usually involving two or more symptoms that may not
disable, but keep a person from feeling good and functioning well.
Bipolar disorder (manic-depressive illness)
While not as common as unipolar depression, bipolar disorder is just
as serious, and is associated with an even higher risk of suicide.

DEPRESSION

DEPRESSION

Bipolar disorder is a brain-based mental illness separate from unipolar

depression. It involves a cycle of mood changes from severe highs (mania)
to severe lows (depression), interspersed with normal periods. Mood
changes may happen quickly, sometimes over the course of a single day,
but more commonly, bipolar disorder involves intensive periods of mania
lasting for several days, followed by lengthy periods of depression. It is
not uncommon for sufferers to be free of symptoms for weeks or even
years in between episodes.

Symptoms of Mania

When in the depressed cycle, an individual may have any or all of the
symptoms of a depressive disorder (see Symptoms of Depression),
and when in the manic cycle, any or all of the symptoms of mania may
be evident (see below). If left untreated, a manic episode may worsen
into a psychotic state requiring hospitalization.

Excessive irritability, aggressive

behavior

Genetics play a role in bipolar disorder, which means you can inherit
a biological vulnerability to develop it, but not everyone with the
vulnerability develops the disorder. People who have a relative with
any type of depression
are at increased risk
for developing bipolar
disorder, but many people
with the condition have
no family history of
depression.

Impulsiveness or poor judgment

Bipolar disorder requires

immediate medical
attention, preferably by a
specialist who is skilled in
managing the condition.
Treatments are available that can help control the symptoms of mania,
and antidepressants and/or psychotherapy may be employed to relieve
depressive symptoms.

Exaggerated optimism and selfconfidence

Decreased need for sleep
without experiencing fatigue
Grandiose delusions, inflated
sense of self-importance

Increased physical and mental

activity
Racing speech, fleeting thoughts, easily distracted
Reckless behavior, such as spending sprees, rash business decisions,
erratic driving, flagrant affairs

Treatment for Depression

Even when depression is recognized, people may not get adequate
treatment. However, once the right therapy is found, the vast majority of
people with depression can be treated effectively, which improves quality
of life and reduces the risk of suicide and premature death from other
medical conditions. A combination of antidepressant medications and
psychotherapy (talk therapy) is often the most effective approach to
treatment, especially in older persons.
Treatment for depression may need to continue for a long time,
perhaps even indefinitely, just as treatment for chronic medical
conditions such as diabetes or high blood pressure must continue
throughout life. People over 75 may respond more slowly to treatment,
or be more susceptible to recurring depression, even with treatment.
Regular and ongoing consultations with a physician experienced in

DEPRESSION

DEPRESSION

treating depression in the elderly is critical, so that treatment

adjustments may be made as necessary.
Current antidepressants influence the function of neurotransmitters.
Three major types of antidepressants are available: tricyclic
antidepressants, monoamine oxidase inhibitors, and selective serotonin
reuptake inhibitors (SSRIs). Developed more recently, SSRIs tend to
have fewer side effects than the older drugs. Different people respond
differently to antidepressants,
and finding the one that
provides effective relief of
symptoms is often a process of
trial and error. Sometimes the
dose may need to be adjusted,
or a combination of
medications may be needed.
The full effect of an
antidepressant may not occur for three to four weeks, sometimes
longer. If improvement is not seen after several weeks on one
medication, another one may be tried, on the doctors
recommendation.
Psychotherapy is an important part of depression treatment, particularly
in older people. The most effective types of psychotherapy for
depression include Cognitive-Behavioral Therapy (CBT) and
Interpersonal Therapy (IPT). Administered by a psychiatric professional
(usually a psychiatrist or licensed psychotherapist), these talk therapies
work to help a person develop strategies for coping with day-to-day
challenges, learn to counter negative thoughts and behaviors that
accompany depression, and resolve any relationship conflicts that may
be contributing to depression. People with short-term depression, such
as that associated with medical illness, trauma, or loss of a loved one,
may benefit from shorter courses of psychotherapy.

Electroconvulsive Therapy
(ECT) remains one of the most
effective yet most stigmatized
treatments for depression. ECT
stimulates specific parts of the
brain with brief low-level
electrical impulses, which are not
consciously felt by the patient.
Several sessions of ECT may be
necessary for full effect. Modern
advances in ECT techniques
have made this a much safer
treatment compared to earlier
decades. While side effects such as memory loss and other cognitive
problems are not uncommon, they are typically short-lived.
With so many effective
treatments available, there is no
reason to let depression rob your
life of joy. Getting the right
treatment is critical, and there
can be comfort in knowing that
it is available. The first step is to
take action: see your doctor, ask
about treatment options, and
follow the therapy prescribed.

DEPRESSION

DEPRESSION

10

11

Living With Depression

Meet with your doctor regularly for ongoing assessments of your
health and progress in treating depressive symptoms.
Set realistic daily goals for yourself, and prioritize your activities.
Break down large tasks into smaller ones that can be accomplished
more readily.
Dont isolate yourself; get out and socialize with other people.
Talk with someone about
your feelings, whether a
friend or family member,
doctor, professional
counselor, or clergy member.
Try to continue participating
in activities that you have
enjoyed.
Exercise regularly; studies
show it improves mood and
overall health.
Give yourself time; even with
treatment, your mood may
not improve immediately,
but you should notice
improvement within a
few weeks.
If you can, postpone important decisions until youre feeling
better, or discuss matters with someone who might have an
objective view.
Dont be afraid to ask for help, and accept help that is offered.
Source: National Institute of Mental Health

If You Suspect Depression in Someone Else

Many times, depression is first recognized by others people close
to the person, who notice a change in mood or behaviors. Family
support can make a huge difference in helping people with depression

get the treatment they need. If you suspect that someone you care
about may be depressed, talk to him or her about it. Gently ask
questions, listen carefully, and watch for telltale signs, such as
decreased interest in favorite activities. Recognize that it may be
easier for some people to acknowledge physical changes, such as
sleep difficulties or loss of appetite, than to talk about feelings such
as worthlessness or hopelessness. Some studies have suggested that
men may have more difficulties than women in talking about such
problems.
Other suggestions:
Help the person get evaluated and treated; be prepared to
accompany him/her to the doctor if necessary.
Encourage the individual to follow treatment regimens properly,
or to seek different treatment if no improvement is seen.
Offer emotional support (understanding, patience, affection,
and encouragement).

DEPRESSION

DEPRESSION

12

13

 Do not ignore remarks about suicide; report them to the persons

doctor or encourage the person to seek help immediately from a
doctor or suicide prevention program.
Reach out to the person: invite him/her to do things, stay in touch
with visits and phone calls, and be a good listener.
Be gentle but persistent in offering help and companionship;
people with depression may avoid other people or resist offers
of help.
Encourage the person gently to become involved in activities
he/she once enjoyed.
Do what you can to minimize demands on the person, so
that he/she does not feel overwhelmed or inadequate.

Conclusion
Depression is not an inevitable part of growing old. It is a serious
medical condition resulting from an imbalance in brain chemicals,
which may be triggered by a number of factors genetic,
psychological, and environmental. Know the warning signs for
depression, and if you notice them in yourself or others, seek medical
attention. There are many treatment options and many ways to get
help and support for coping with depression (see Resources, page 16).
The good news from brain research is that the vast majority of people
with depression can be treated effectively, often with a combination of
medications and psychotherapy. Dont let depression steal the joy from
your life, or the life of someone close to you, especially not at the very
time you should be enjoying life to the fullest.

DEPRESSION

14

Resources
AARP

NRTA: AARPs Educator

Community

The Dana Alliance

for Brain Initiatives

Director
Annette Norsman

Chairman
William Safire

National Coordinator
Megan Hookey

President
Edward F. Rover

Membership Manager
Michael C. Patterson

Vice Chairmen
Eric R. Kandel, M.D.
James D. Watson, Ph.D.

www.aarp.org

Depression Awareness Recognition and Treatment Education

Program (D/ART)
Tel: (800) 421-4211 (Free Brochures)
Depression and Related Affective Disorders Association (DRADA)
www.med.jhu.edu/drada

National Alliance for the Mentally Ill

Tel: (703) 524-7600; (800) 950-NAMI; Fax: (703) 524-9094
www.nami.org

National Alliance for Research on Schizophrenia and Depression

(NARSAD)
Tel: (800) 829-8289; Fax: (516) 487-6930
www.mhsource.com/narsad.html

National Depressive and Manic-Depressive Association

Tel: (800) 826-3632; Fax: (312) 642-7243
www.ndmda.org

National Foundation for Depressive Illness

Tel: (800) 239-1265
www.depression.org

National Institute of Mental Health

Tel: (301) 443-4513; Fax: (301) 443-4279
Depression brochures: (800) 421-4211; TTY: (301) 443-8431;
FAX4U: (301) 443-5158
www.nimh.nih.gov

National Mental Health Association

Tel: (703) 684-7722; (800) 969-6642
FAX: (703) 684-5968
TTY: (800) 433-5959

Senior Legislative Representative

Nancy H. Aronson

Executive Committee
Marilyn S. Albert, Ph.D.

Field Consultants
Bill Latham
Sharon Smith

Nancy C. Andreasen, M.D., Ph.D.

Community Service Consultant

Rebecca Villarreal

Dennis Choi, M.D., Ph.D.

Colin Blakemore, Ph.D., Sc.D., F.R.S.

Floyd E. Bloom, M.D.
Leon N. Cooper, Ph.D.
Joseph T. Coyle, M.D.

Program Assistant
Genaro (Gene) Ruiz
601 E Street, NW
Washington, DC 20049
Tel: (202) 434-2380
Fax: (202) 434-6457
Web site: www.aarp.org/nrta

Fred H. Gage, Ph.D.

Zach W. Hall, Ph.D.
Kay Redfield Jamison, Ph.D.
Joseph B. Martin, M.D., Ph.D.
Guy M. McKhann, M.D.
Herbert Pardes, M.D.
Steven M. Paul, M.D.
Fred Plum, M.D.
Carla Shatz, Ph.D.

www.nmha.org

On Our Own
Tel: (410) 444-4500; Fax: (410) 444-8755

Executive Director
Barbara E. Gill
745 Fifth Avenue, Suite 900
New York, NY 10151
Tel: (212) 223-4040
Fax: (212) 593-7623
E-mail: [email protected]

The Dana Foundation

www.dana.org

Web site: www.dana.org

DEPRESSION

16

Editor: Brenda Patoine

Project Manager: Laura Reynolds
Design: AARP Creative
Photography: Maureen Keating, pages 3, 9,
10, 13; Linda Bartlett, page 8