We seniors are particularly susceptible to holiday and other depressions that are subtle in their symptoms. Unmet expectations for the holidays, memories of those no longer there (especially a recent bereavement), worsening chronic disease, financial worries, any stressful (even desirable) change in lifestyle such as retirement or moving to a new residence can trigger depression.

Depression is often missed by physicians who tend to concentrate on the physical condition of their patients. As a person ages, signs of depression can be dismissed as crankiness or grumpiness. Confusion or attention problems caused by depression can look like Alzheimer's disease or other brain disorders. Mood changes and other signs of depression can be caused by medications that may have been prescribed for high blood pressure or heart disease. In addition, seniors may be reluctant to discuss their feelings of sadness, hopelessness, and loss of interest in normally pleasurable activities. Some may feel that depression is a sign of weakness, or that one should just "snap out of it," or that being depressed is a normal part of growing older. Nothing could be further from the truth.

Occasional feelings of sadness are normal, but prolonged periods of unrelenting depression (more than two weeks) are not a normal part of aging. Although older people may have to deal with the death of family and friends, or chronic or life-threatening illnesses, most elderly people cope well with and manage to live satisfying, happy lives. The good news is that even those who fall prey to depression can recover with the right treatment.

Early identification and intervention is important. Depression has an adverse effect on quality of life; depressed patients take more pain medications, are more likely to develop heart disease, and recover from illnesses more slowly.

The signs of depression can include loss of appetite, increasing isolation and withdrawal, weight loss or gain, sleeping disturbances, agitation, fatigue, sadness, feelings of worthlessness, difficulties with concentration and/or memory, lack of attention to personal care and thoughts of suicide. Talk of suicide should never be ignored. Among elderly white males, in particular, the suicide rate is six times the national average. Amazingly, 70 percent of these patients were seen by a doctor within several months before their deaths. Although women experience depression about twice as often as men, the rate of suicide in men is four times that of women, and that rate increases as men age until the rate peaks at age 85. However, suicide rates do not increase with age among women.

Professional help should be obtained immediately for anyone who feels that life is not worth living.

Severe depression can have physical or medical causes. A thorough history and physical examination should be done by the attending physician. A complete review of medications and possible drug abuse, including use of prescribed and over-the-counter drugs. Drug abuse can occur when a patient attempts to self-medicate for depression. While drugs may relieve symptoms for a time, they do not address the cause of the depression. Some illnesses (stroke, heart attack, cancer, etc.) and a few medications can lead to depression-like symptoms; once these are dealt with, the patient's depression can be alleviated by the proper treatment.

Some studies suggest that nutritional supplements such as vitamin B-12 may be helpful. Another small but interesting study of 12 subjects found that aerobic exercise substantially reduced depression in six subjects, slightly reduced depression in two, and the remaining four were about the same. Interestingly, the responses to exercise were rapid, unlike that of medication, which can take a number of weeks to show any effect and usually has unwanted effects.

Chiropractic treatment can be helpful, says Dr. Douglas Murray, of the Santa Teresa Chiropractic Center in San Jose. "If there is a disturbance in the spine--specifically the upper cervical spine--chiropractic adjustment can indeed affect the mood of the person, including depression," he says, "and this could help alleviate the depression."

The more traditional approach to lessening depression is by using medications and/or psychological therapy. Some researchers have a preference for therapy without drugs unless the depression is severe.

Seniors are sensitive to common drugs used to combat depressive symptoms, so the physician will start with half the usual dose and titrate up as needed. The psychological therapies often preferred are the behavioral and cognitive, which are used to reintegrate the patient into a social environment. Behavioral therapy helps to develop better coping skills. Cognitive therapy helps the depressed person recognize which life problems are critical and which are minor; it also helps them to accept the life problems that can't be changed.

"Depression can have a devastating impact on general functioning and quality of life," says Polly Hitchcock Noel, assistant professor of medicine at the University of Texas Health Science Center at San Antonio. She is also the author of a recent study in 1,801 patients that concluded that patients who received treatment for depression were less impaired or debilitated by their accompanying illnesses (cancer, diabetes, arthritis, etc.).

For more information about depression, contact the National Mental Health Association at 800.969.6942.