Most older adults are healthy, leading independent and fulfilling lives. They are socially active and engaged in leisure pastimes, volunteering in their communities or busy with family and friends. For those older adults who do suffer from depression, the ability to participate decreases as the depression takes over. Often people describe a feeling of lacking energy, of having no interest in day-to-day happenings, and being listless and not knowing why.

Depression is the most common mental health concern for older adults, affecting some 15 to 20 percent living in the community. It is not a normal part of aging. Symptoms such as decreased energy, poor sleep and preoccupation with health problems should be viewed as possible symptoms of treatable illness and are NOT a result of the aging process.

Until recently, many older people have been reluctant to talk about depression. The time has come to talk openly about this serious illness. The good news is that when depression is identified early and properly diagnosed, older adults respond well and most often can return to their usual healthy, independent and fulfilling lives.

There is still much to be learned about the causes of depression, especially in older adults. In fact it is likely that a combination of physical, psychological and social factors that come with aging may increase the risk of depression in old age. What is known is that there is no one cause for depression - every individual is unique in what may cause his or her depression, and what may trigger a depressive episode. Some possible causes and risk factors include genetics and family history, brain chemistry, personality, major illness, medications and alcohol, and life events. Risk factors for serious depression, particularly in older adults, may include loss and bereavement, lack of social support, isolation, living in poverty, being a caregiver, and abuse.

Treatment for depression works, yet too many people remain undiagnosed and untreated because they don't recognize the signs and symptoms. Mental health specialists generally agree on the following definition of major depression:

• Symptoms persist for two weeks or longer
• People either have depressed moods or seem unable to enjoy life.

1. A change in sleeping habits (more or less than usual)
2. A change in eating habits or weight
3. Low energy or fatigue
4. Trouble concentrating
5. Feeling worthless or excessively guilty
6. Marked restlessness or slowed-down movements
7. Thoughts of death or suicide

Depression can be defined as an imbalance of brain chemicals triggered by stress and life events, including biological, psychological and social factors. It is NOT a character flaw or personality flaw. Many of the signs of depression may also indicate other problems or medical conditions. It is important to consult with a doctor to determine if your symptoms indicate depression or another medical condition.

Many older persons don't seek treatment for depression, despite the good news that treatment works. One major reason why many do not seek help is the stigma surrounding depression. The stigma around mental illness affects older adults much more profoundly than it does young adults because of the misconceptions that depression is a natural accompaniment of aging; that it is somehow okay for older adults to be depressed.

Again - depression is NOT a normal part of aging and should not be accepted as such. It is now understood that depression is a very real and treatable illness. People must learn to talk openly about depression and seek help for family members and themselves. Even when older adults approach health care professionals for help they don't always use the word 'depression' or even recognize their symptoms as a sign of depression. Sometimes they complain of aches and pains. Trained professionals can distinguish between mood disorders such as depression and other medical conditions.

Depression can easily be confused with symptoms of another medical condition. Conditions that are common with aging (e.g. dementia, stroke, and Parkinson's disease) can be associated with or complicated by depression. However, common depressive symptoms such as decreased energy and interest, poor sleep and increasing preoccupation with health problems, should be seen as possible symptoms of depression rather than as inevitable results of the aging process.

Many older people simply do not know where to go for help, even if they want it. As a result, they never get treated for depression. While a medical assessment is a good place to start, there are other community resources where you can ask questions and get information. Many people in need of help visit a family doctor or other health professional. If the health care provider feels that the patient's depression is of a more serious nature, that person may be referred to a psychologist or to a psychiatrist. When anti-depressant medication is needed, referral might be to a psychiatrist. The family doctor also can prescribe anti-depressant medication and can work together with a mental health specialist in helping to treat depression.

Talking to someone who understands depression is the first step in moving forward to beat it. Sharing concerns with a doctor, nurse, social worker, faith leader, staff or volunteers at a seniors' centre or club, or with some trusted person will help get the beneficial support.

For more information see Depression…It's Just Part of Getting Old - Right? Wrong!!! the Facts on Aging and Depression for Older Adults and Those Who Care about Them at www.opmhan.ca.

Randi Fine, Toronto