UNC Health Care
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Spotting Depression in Older Adults

Depression is common in older adults, but it’s too often missed or ignored. People assume that it’s a normal part of old age to be persistently sad (it’s not) or that it’s weak to ask for help (it’s not).

Although aging comes with challenges, depression doesn’t have to be one of them. If you or someone you love might be depressed, there are ways to feel better and professionals who can help. Here’s what to know.

Signs of Depression in Older Adults

It’s hard to know just how many older adults are depressed because they often use different language to describe depression, given the stigma around it in this population, says UNC Health geriatric psychiatrist Julia Lunsford, MD.

“They may not necessarily acknowledge that they’re sad, but they may talk about anxiety or irritability or maybe having pain, which might then lead a person who’s paying attention to realize this could actually be depression even though they may not call it that,” Dr. Lunsford says.

Here are common signs of depression in the elderly:

  • Increased irritability
  • Changes in appetite—eating too much or too little
  • Changes in sleep—sleeping too much or too little
  • Becoming withdrawn and spending more time alone
  • Inability to enjoy things as much as they used to
  • Feeling lonely, bored or helpless
  • Forgetfulness
  • Persistent pain
  • Expressing thoughts of death or suicide

Major depressive disorder, which causes a persistent feeling of sadness, a loss of interest in activities and changes in daily functioning, occurs in 2 to 5 percent of older adults, Dr. Lunsford says.

The most common type of depression in older adults, though, is a milder form called persistent depressive disorder that “does not cause much impairment or dysfunction,” she says, but it still worsens quality of life.

Risk Factors for Depression in Older Adults

Although Dr. Lunsford says it is unknown what causes later-in-life depression, risk factors include:

  • Being female (women are at much higher risk of depression than men)
  • Lack of social support
  • Loss of a loved one
  • Having a chronic medical condition or chronic pain
  • Hearing and visual impairment
  • Dementia or cognitive impairment

“Depression often can be part of what we call a bidirectional condition, where depression is thought to be a risk factor itself for dementia, but dementia could be also responsible for depression,” Dr. Lunsford says. “It goes both ways.”

Get Help if You or a Loved One Feels Depressed

First and foremost, if you or your loved one feels suicidal, seek help immediately. Call 911 or go to the nearest emergency department. You also can call the National Suicide Prevention Lifeline at (800) 273-8255.

Don’t be afraid to ask your loved one if he or she feels depressed.

“For older people, there may be a significant stigma, so sometimes family members or friends are reluctant to bring it up,” Dr. Lunsford says.

However, showing your concern can be a lifeline for a person with depression, including an older person. And asking people if they’re having suicidal thoughts does not make them more likely to act on them, Dr. Lunsford says.

If you’re unsure whether you may be depressed, talk to your primary care physician.

“Talking to your primary care provider could be a great way to start, especially if it’s somebody who knows you well and you have an ongoing relationship with them,” Dr. Lunsford says. “They’re very capable of making a first step toward trying to help you get treatment.”

Your doctor may prescribe an antidepressant or recommend you talk to a therapist.

“A therapist can provide support and strategies for coping,” Dr. Lunsford says. “I find that people are grateful for the chance to talk, process and reflect. And sometimes it may be easier to talk to a psychiatrist or a therapist than a family member.”

When choosing a therapist, keep in mind that it may take time to find the right fit.

Although professional help is often most effective to relieve the symptoms of depression, there are steps you can take to boost your mood on your own, too. Light exercise and a healthy, balanced diet can make a real impact on how you feel in just a few days.

“Going outside for a walk can be one of the best treatments of all, as is focusing on nutrition and diet,” Dr. Lunsford says.

You can exercise your brain by trying a new hobby, such a line dancing, painting or doing a daily crossword puzzle. Finally, turn off the news and turn on some music, Dr. Lunsford says.

“Do something other than watching the evening news, which may itself be a stressor right now. We want to be informed, but that can be very triggering and upsetting for a lot of people,” Dr. Lunsford says. “Music is a very helpful treatment for depression. Listen to the music that you’ve enjoyed over the years.”


If you think you may be depressed, talk to your doctor. Need a doctor? Find one near you or set up a virtual appointment. If you feel you’re in immediate danger, call 911 or the National Suicide Prevention Lifeline at (800) 273-8255.