Why depression in older adults can be easy to miss

(Aging Untold) — In older adults, depression does not always present as crying or obvious sadness. It may appear instead as irritability, social withdrawal, excessive sleeping, or other changes that can be easy to overlook.

The Aging Untold experts explain the warning signs, why seniors face particular risk, and what can help.

Signs are often mistaken for something else

Dr. Rhea Rogers, a board-certified physician, said some of the most common clues are withdrawal and a loss of interest in activities. People may sleep for long stretches, turn to substance abuse, or seem unkempt.

She said depression in older adults can also look like memory decline.

“A lot of times in the older person, it may show up as kind of memory starting to go, as well. It may not come about the way that you think it is,” Rogers said.

It is not normal aging, and it is not uncommon

The experts pointed to troubling suicide data involving older adults.

According to the Centers for Disease Control and Prevention, the highest suicide rate in 2024 was among adults 80 and older.

“We have an epidemic going on of depression, and it’s not normal aging,” gerontologist Sam Cradduck said. “That’s the problem — so many people think, ‘Well, you should be sad, you’re old,’ or ‘You should expect to lose your spouse or leave your home.’”

She said the accumulation of losses later in life can make coping much harder.

“There’s a lot of loss, and there’s not a lot of friendship that still exists once you start losing so many. So you lose your partner that you’re bouncing things off of, you lose that comfort, and then you’ve got to deal with all these other things,” Cradduck said.

Hormones, nutrition and purpose can all matter

Depression is not driven only by grief. Physical and chemical factors can also play a major role.

“It’s not the most common reasons that people think either — hormonal shifts are a big thing, or vitamins, nutrient deficiencies and all that. That can affect mood and things like that as well. And then that loss of purpose — that’s a big deal,” Rogers said.

Treatment can help, and coverage may already be there

Aging expert Amy O’Rourke shared the story of a client whose life changed after getting treatment.

“I had a client that was so depressed, one of those that couldn’t get out of bed, and he went to the hospital for treatment for depression, and the outcome was miraculous. He got his life back. He lived independently. The family was blown away. And it really taught me a lesson about really being proactive about getting this depression under control.”

She added that cost does not necessarily have to keep people from getting help. People with Medicare or a Medicare Advantage plan may receive an annual wellness visit that includes depression screening.

“A lot of people will say, ‘I can’t afford it.’ Well, if you’ve got Medicare or a Medicare Advantage plan, you’ve got an annual wellness visit. They do a depression screening and you can get mental health help. There’s not a visit limit — I’m going to be a mythbuster here. There’s not a visit limit.”

The greater cost is avoiding care

Rogers pushed back on the idea that mental health treatment is optional or too costly to pursue.

“I don’t think people realize the worst outcome they can come up with. They think, ‘I can’t afford to get help.’ You can’t afford not to,” Rogers said.

Aging well coach Katherine Ambrose added: “Can you afford dementia? And do you want some of these other things to happen to you? If you can, turn it around.”

Breaking the stigma

The experts said depression should be treated like any other medical issue.

“Don’t be ashamed. That’s no different than your heart getting help, you know? You go to the heart doctor. That’s no different than your knees, so your brain is just as important, if not more, because it’s controlling everything else,” Rogers said.

Cradduck also criticized the “bootstraps” mentality that can keep people from seeking help.

“We have this mindset about mental health that the person that’s suffering can just pull their bootstraps up, that they can just get over it, that if you would just choose to be happy, if you would choose to get out of bed, if you choose to do it different... We have to realize that there becomes a chemical imbalance. Depression isn’t just, ‘I’m going to change my mood’ — it’s the chemicals in my brain have changed. And maybe I need an antidepressant. Maybe I need some help to get through this. But if I don’t get through this, the outcome is not OK.”

They also said stigma can extend to medication.

“This is a temporary thing that you’re doing to get yourself up and going, and then you might have the energy to go walking or do something that makes your energy level get higher,” O’Rourke said.

“You notice people don’t have a stigma around taking high blood pressure meds,” Rogers added.

How to begin

“I would start with your medical doctor. I think therapy’s a great answer, but also getting out and being social and finding purpose and fun again — it’s really important. And remember, you’re showing other people how to live as well and how to cope,” Ambrose said.

She ended with a message of encouragement for anyone unsure about getting help: “Here’s your opportunity to make the rest of the years that you have left your best years. ... They’re the only years you have left.”

Resources

• The Friendship Line: 1-800-971-0016
  • The Friendship Line provides crisis support for people who are 60 and up.

• If you are facing mental health struggles or emotional distress, dial 988 to reach the Suicide and Crisis Lifeline anytime.

Key takeaways

1. Depression does not always look like sadness. In older adults, it can show up as irritability, withdrawal, sudden changes in sleep, or a decline in hygiene.
2. Depression is treatable. Getting help can support memory and cognitive function.
3. Help may already be covered. Start with your doctor. Medicare and Medicare Advantage plans include an annual wellness visit with a depression screening, and there is no visit limit on mental health care.
4. Treatment is nothing to be ashamed of. Seeking help for depression should be treated the same as care for the heart, knees or blood pressure.
5. Factors go beyond grief. Hormonal shifts, nutrient deficiencies and loss of purpose can all affect mood.