It’s Never Too Late to Get Help: Understanding Depression in Older Adults

Depression can affect anyone, regardless of age, background, or life circumstances. But one group that often gets overlooked in the mental health conversation is older adults, especially those who start experiencing depression later in life. This is called late-onset depression, and it can be tricky. It’s often harder to recognize, more difficult to treat, and sometimes even linked to other health issues like dementia.

Depression Is Not a Normal Part of Aging

While it’s natural to feel sadness or grief with life changes, depression is not a normal part of aging. According to the National Institute on Aging (NIA), depression is a serious yet treatable mood disorder. Many older adults report high life satisfaction, even with physical challenges, but depression can still strike, especially when triggered by factors like chronic illness, the loss of a loved one, or social isolation.

Types of depression common among older adults include:

• Major Depressive Disorder – symptoms that interfere with daily life for at least two weeks
• Persistent Depressive Disorder (Dysthymia) – long-lasting but milder symptoms
• Depression related to medical conditions or medications

Recognizing the Symptoms

Depression in older adults can look different than in younger people, with signs like sadness, low energy, sleep changes, and trouble concentrating. These symptoms can resemble dementia, which is why a proper medical evaluation is so important, especially since depression and dementia can occur together or in sequence.

According to Dr. Jose Bejarano, one of Legacy’s bilingual psychiatrists, clinicians should be aware that some elderly and depressed individuals in the community do not exhibit the depression or depressive mood observed among severely depressed patients who visit psychiatric hospitals.

“Depressive mood is a symptom that is difficult to notice even by specialists,” said Dr. Bejarano. “To identify depressed individuals, it is helpful to look for a decrease in interest and pleasure, which is a main characteristic of depression in older adults.”

Racial Disparities in Late-Life Depression

Depression affects people of all backgrounds, but it’s often underreported—especially in Black communities—due to stigma and barriers to care. According to the National Institute of Mental Health, Black adults report depression less frequently than white adults, but the actual rates may be higher.

The American Psychiatric Association notes that Black Americans are more likely to be misdiagnosed and less likely to receive guideline-based care. A 2020 JAMA Psychiatry study found that severe depression was more common among Black and Hispanic older adults, who reported higher levels of sadness, loss of pleasure, and slowed thinking or movement.

Depression and Cognitive Decline: A Two-Way Street

Research shows a strong link between late-onset depression (starting at age 60 or older) and dementia.

Those with late-life depression often experience more cognitive decline and a higher risk of dementia. In contrast, early-onset depression is usually tied to long-term stress and leads to slower cognitive decline. Experts believe late-onset depression may signal underlying neurodegenerative changes.

Dr. Bejarano explains: “Sometimes depression in the elderly can cause pseudo-dementia (an apparent intellectual decline from the lack of energy-effort). These people are forgetful, slower, and have low motivation. They may look depressed. Symptoms usually respond well to treatment for depression.”

Here are some keys he offers to help differentiate between depression and dementia:

• Decline in mental functioning tends to be more rapid with depression than with Alzheimer’s or another type of dementia.
• People with depression are usually not disoriented, with Alzheimer’s or other dementia they are.
• People with depression have difficulty concentrating, whereas those affected by Alzheimer’s have problems with short-term memory.
• Writing, speaking, and motor skills aren’t usually impaired in depression.
• Depressed people could notice and comment on their memory problems, while those with Alzheimer’s may not.

Stigma and Silence in Older Communities

Cultural attitudes can also shape how older adults experience and respond to depression. Many older individuals, especially in communities of color, may believe depression is a personal weakness, distrust the healthcare system, or feel shame in discussing mental health struggles

This leads to underreporting, delays in treatment, and unnecessary suffering. In fact, untreated depression is a major risk factor for suicide, particularly in older adults from marginalized backgrounds. A 2022 JAMA study found elevated suicide risk among older adults from Black, Hispanic, and American Indian communities.

What You Can Do

If you or a loved one is experiencing signs of depression:

• Talk to a doctor or mental health professional
• Stay socially connected
• Encourage physical activity and a healthy diet
• Avoid isolation
• Know the warning signs of suicide

Dr. Bejarano emphasizes the vital role that caregivers play: “These patients are prone to feelings of self-doubt and helplessness because they can no longer do what they used to be able to do, and it is desirable for those around them to treat them in a supportive manner.”

However, caregivers can become overwhelmed, especially with behavioral and psychological symptoms that come with both depression and dementia. “This may lead to depression and resentment toward the patient,” says Dr. Bejarano, “which can damage the relationship. In such cases, not only a supportive attitude toward the patient but also social support – such as disease education for caregivers and application for long-term care insurance – are effective.”

Effective Treatments for Late-Onset Depression

The good news is that depression is treatable, and there are several options that can help. Talk therapy, especially Cognitive Behavioral Therapy (CBT), can be really effective, along with medications like SSRIs. Making healthy lifestyle changes, such as staying active and connected, can also make a big difference.

According to Dr. Bejarano, “There are no specific treatments for late-onset depression, but a combination of medication management and psychotherapy has shown good results. Besides other co-morbidities such as health-social issues that may interfere with recovery, it is advised to use a comprehensive approach to evaluate and treat late-onset depression in the elderly.”

Let Legacy Be a Lifeline for Mental Health Support

Maintaining mental wellness is a lifelong process. At Legacy Community Health, we believe it’s never too late to seek help – and it’s never too early to begin the conversation.

Whether it’s speaking with a therapist or getting the right treatment, support is available. To make an appointment with one of our doctors or behavioral health professionals, visit www.legacycommunityhealth.org or call today.

If someone is in crisis, don’t wait – call the 988 Suicide & Crisis Lifeline or 800-273-TALK (8255), or visit the nearest hospital emergency room.