Skip to main content
SpringerLink
Log in

Depression in Late Life: Etiology, Presentation, and Management

  • Reference work entry
  • First Online:
Book cover Mental Health and Illness of the Elderly

Part of the book series: Mental Health and Illness Worldwide ((MHIW))

Abstract

Depression in late life is common with a community prevalence of approximately 15%. The figures are higher among hospital inpatients (20–25%) and patients in long-term care (10–40%). It is the most frequent cause of emotional suffering in the elderly and can have a significant impact on a person’s physical health and cognitive and social functioning. Suicide among older adults is more often associated with depression than at any other age, and suicide attempts are more likely to be fatal. Depression in late life may refer to either depression with first onset in later life (late-onset depression) or depression that occurs for the first time in younger years and recurs in later life (early-onset depression). The two syndromes differ in terms of etiology, presentation, and natural history. Late-onset depression can be considered to be a geriatric syndrome similar to frailty, falls, or incontinence. Affective symptoms may be less to the fore with motivational-type symptoms and somatic complaints relatively more prominent. The physiological and psychological effects of poor physical health and the organic changes of the aging brain are fundamental considerations in this age group. Successful management of depression in late life, regardless of the subtype, requires a flexible and thoughtful multidisciplinary approach. While pharmacotherapy undoubtedly plays a vital role in moderate to severe cases, it must be used cautiously given the increased risk of adverse side effects in the elderly. Physical health, social disconnection, and functional or occupational decline must also be identified and targeted according to the individual needs and abilities of the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 279.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Alexopoulos GS, Meyers BS, Young RC, Kakuma T, Silbersweig D, Charlson M (1997) Clinically defined vascular depression. Am J Psychiatry 154(4):562–565

    Article  CAS  PubMed  Google Scholar 

  • Alexopoulos GS, Katz IR, Reynolds 3rd CF, Carpenter D, Docherty JP (2001) The expert consensus guideline series. Pharmacotherapy of depressive disorders in older patients. Postgraduate medicine Spec No Pharmacotherapy:1–86

    Google Scholar 

  • Alexopoulos GS, Kiosses DN, Klimstra S, Kalayam B, Bruce ML (2002) Clinical presentation of the “depression-executive dysfunction syndrome” of late life. Am J Geriatr Psychiatry 10(1):98–106

    PubMed  Google Scholar 

  • Alexopoulos GS, Raue PJ, Kiosses DN, MacKin RS, Kanellopoulos D, McCulloch C, Areán PA (2011) Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Arch Gen Psychiatry 68(1):33–41

    Article  PubMed  PubMed Central  Google Scholar 

  • APA (2010) Practice guideline for the treatment of patients with major depressive disorder. Internet

    Google Scholar 

  • Baldwin RC, Gallagley A, Gourlay M, Jackson A, Burns A (2006) Prognosis of late life depression: a three-year cohort study of outcome and potential predictors. Int J Geriatr Psychiatry 21(1):57–63

    Article  PubMed  Google Scholar 

  • Barnes DE, Yaffe K, Byers AL, McCormick M, Schaefer C, Whitmer RA (2012) Midlife vs late-life depressive symptoms and risk of dementia. Arch Gen Psychiatry 69(5):493–498

    Article  PubMed  PubMed Central  Google Scholar 

  • Blazer DG (2003) Depression in late life: review and commentary. J Gerontol – Ser Biol Sci Med Sci 58(3):249–265

    Article  Google Scholar 

  • Braam AW, Copeland JRM, Delespaul PAEG, Beekman ATF, Como A, Dewey M, Fichter M, Holwerda TJ, Lawlor BA, Lobo A, Magnússon H, Prince MJ, Reischies F, Wilson KC, Skoog I (2014) Depression, subthreshold depression and comorbid anxiety symptoms in older Europeans: results from the EURODEP concerted action. J Affect Disord 155(1):266–272

    Article  PubMed  Google Scholar 

  • Butters MA, Klunk WE, Mathis CA, Price JC, Ziolko SK, Hoge JA, Tsopelas ND, Lopresti BJ, Reynolds ICF, DeKosky ST, Meltzer CC (2008) Imaging Alzheimer pathology in late-life depression with PET and Pittsburgh compound-B. Alzheimer Dis Assoc Disord 22(3):261–268

    Article  PubMed  PubMed Central  Google Scholar 

  • Chi I, Chou KL (2001) Social support and depression among elderly Chinese people in Hong Kong. Int J Aging Hum Dev 52(3):231–252

    Article  CAS  PubMed  Google Scholar 

  • Choi NG, Kim J, Marti CN, Chen GJ (2014) Late-life depression and cardiovascular disease burden: examination of reciprocal relationship. Am J Geriatr Psychiatry 22(12):1522–1529

    Article  PubMed  PubMed Central  Google Scholar 

  • Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, Haddad PM, Katona C, Lewis G, Malizia A, McAllister-Williams RH, Ramchandani P, Scott J, Taylor D, Uher R (2015) Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol (Oxford, England) 29(5):459–525. doi:10.1177/0269881115581093

    Article  CAS  Google Scholar 

  • Cole MG, Dendukuri N (2003) Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. Am J Psychiatry 160(6):1147–1156

    Article  PubMed  Google Scholar 

  • Conwell Y, Duberstein PR, Caine ED (2002) Risk factors for suicide in later life. Biol Psychiatry 52(3):193–204

    Article  PubMed  Google Scholar 

  • Denihan A, Kirby M, Bruce I, Cunningham C, Coakley D, Lawlor BA (2000) Three-year prognosis of depression in the community-dwelling elderly. Br J Psychiatry 176:453–457

    Article  CAS  PubMed  Google Scholar 

  • Devanand DP, Kim MK, Paykina N, Sackeim HA (2002) Adverse life events in elderly patients with major depression or dysthymic disorder and in healthy-control subjects. Am J Geriatr Psychiatry 10(3):265-274

    Google Scholar 

  • Dwivedi Y (2013) Involvement of brain-derived neurotrophic factor in late-life depression. Am J Geriatr Psychiatry 21(5):433–449

    Article  PubMed  PubMed Central  Google Scholar 

  • Fahy S, Lawlor BA (2001) Discontinuation of lithium augmentation in an elderly cohort. Int J Geriatr Psychiatry 16(10):1004–1009

    Article  CAS  PubMed  Google Scholar 

  • Firbank MJ, Teodorczuk A, Van Der Flier WM, Gouw AA, Wallin A, Erkinjuntti T, Inzitari D, Wahlund LO, Pantoni L, Poggesi A, Pracucci G, Langhorne P, O’Brien JT (2012) Relationship between progression of brain white matter changes and late-life depression: 3-year results from the LADIS study. Br J Psychiatry 201(1):40–45

    Article  PubMed  Google Scholar 

  • Forester BP, Streeter CC, Berlow YA, Tian H, Wardrop M, Finn CT, Harper D, Renshaw PF, Moore CM (2009) Brain lithium levels and effects on cognition and mood in geriatric bipolar disorder: a lithium-7 magnetic resonance spectroscopy study. Am J Geriatr Psychiatry: Off J Am Assoc Geriatr Psychiatry 17(1):13–23. doi:10.1097/JGP.0b013e318172b3d0

    Article  Google Scholar 

  • Gallagher D, Mhaolain AN, Greene E, Walsh C, Denihan A, Bruce I, Golden J, Conroy RM, Kirby M, Lawlor BA (2010) Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults. Int J Geriatr Psychiatry 25(10):981–987

    Article  PubMed  Google Scholar 

  • Gallagher D, O’Regan C, Savva GM, Cronin H, Lawlor BA, Kenny RA (2012) Depression, anxiety and cardiovascular disease: Which symptoms are associated with increased risk in community dwelling older adults? J Affect Disorders 142(1–3):132–138

    Google Scholar 

  • Gallo JJ, Rabins PV, Lyketsos KG, Tien AY, Anthony JC (1997) Depression without sadness: Functional outcomes of nondysphoric depression in later life. J Am Geriatr Soc 45(5):570–578

    Google Scholar 

  • Galvez V, Ho KA, Alonzo A, Martin D, George D, Loo CK (2015) Neuromodulation therapies for geriatric depression. Current Psychiatry Report 17(7):59. doi:10.1007/s11920-015-0592-y

    Article  Google Scholar 

  • George D, Kumar D, Hadzi-Pavlovic D, Leyden J, Wark H, Harper S, Brodaty H, Loo C (2016) Randomised controlled trial of ketamine in depressed elderly. Biol Psychiatry 79(9):156S

    Google Scholar 

  • Goldberg DP, Huxley P (1992) Common mental disorders: a bio-social model. Routledge, London

    Google Scholar 

  • Golden J, Conroy RM, Bruce I, Denihan A, Greene E, Kirby M, Lawlor BA (2009) Loneliness, social support networks, mood and wellbeing in community-dwelling elderly. Int J Geriatr Psychiatry 24(7):694–700

    Article  PubMed  Google Scholar 

  • Gunning-Dixon FM, Walton M, Cheng J, Acuna J, Klimstra S, Zimmerman ME, Brickman AM, Hoptman MJ, Young RC, Alexopoulos GS (2010) MRI signal hyperintensities and treatment remission of geriatric depression. J Affect Disord 126(3):395–401

    Article  PubMed  PubMed Central  Google Scholar 

  • Gustavson KA (2011) Late life depressed mood: Crafting meaning from experience and knowledge. Am J Geriatr Psychiatry 19(3):S92–S93

    Google Scholar 

  • Hewett K, Chrzanowski W, Jokinen R, Felgentreff R, Shrivastava RK, Gee MD, Wightman DS, O’Leary MC, Millen LS, Leon MC, Briggs MA, Krishen A, Modell JG (2010) Double-blind, placebo-controlled evaluation of extended-release bupropion in elderly patients with major depressive disorder. J Psychopharmacol 24(4):521–529

    Article  CAS  PubMed  Google Scholar 

  • Holvast F, Burger H, De Waal MMW, Van Marwijk HWJ, Comijs HC, Verhaak PFM (2015) Loneliness is associated with poor prognosis in late-life depression: longitudinal analysis of the Netherlands study of depression in older persons. J Affect Disord 185:1–7

    Article  PubMed  Google Scholar 

  • Horr TB, Dale R, Finnegan N, Frankel M (2014) Ketamine: a potential option for treatment-refractory depression in elder adults. J Am Geriatr Soc 62:S179

    Google Scholar 

  • Ivan Santini Z, Koyanagi A, Tyrovolas S, Haro JM (2015) The association of relationship quality and social networks with depression, anxiety, and suicidal ideation among older married adults: findings from a cross-sectional analysis of the Irish Longitudinal Study on Ageing (TILDA). J Affect Disord 179:134–141

    Article  Google Scholar 

  • Karlamangla AS, Singer BH, McEwen BS, Rowe JW, Seeman TE (2002) Allostatic load as a predictor of functional decline: MacArthur studies of successful aging. J Clin Epidemiol 55(7):696–710

    Article  PubMed  Google Scholar 

  • Kirby M, Bruce I, Radic A, Coakley D, Lawlor BA (1997) Mental disorders among the community-dwelling elderly in Dublin. Br J Psychiatry 171:369–372

    Article  CAS  PubMed  Google Scholar 

  • Koorevaar AML, Comijs HC, Dhondt ADF, Van Marwijk HWJ, Van Der Mast RC, Naarding P, Voshaar RCO, Stek ML (2013) Big five personality and depression diagnosis, severity and age of onset in older adults. J Affect Disord 151(1):178–185

    Article  CAS  PubMed  Google Scholar 

  • Krishnan KRR, Taylor WD, McQuoid DR, MacFall JR, Payne ME, Provenzale JM, Steffens DC (2004) Clinical characteristics of magnetic resonance imaging-defined subcortical ischemic depression. Biol Psychiatry 55(4):390–397

    Google Scholar 

  • Liebetrau M, Steen B, Skoog I (2008) Depression as a risk factor for the incidence of first-ever stroke in 85-year-olds. Stroke 39 (7):1960-1965

    Google Scholar 

  • Luanaigh CÓ, Lawlor BA (2008) Loneliness and the health of older people. Int J Geriatr Psychiatry 23(12):1213–1221

    Article  PubMed  Google Scholar 

  • Maust DT, Oslin DW, Thase ME (2013) Going beyond antidepressant monotherapy for incomplete response in nonpsychotic late-life depression: a critical review. Am J Geriatr Psychiatry 21(10):973–986

    Article  PubMed  Google Scholar 

  • McCrory C, Gallagher D, Kenny RA (2013) Control orientation as a mediator of the social gradient in depression: a role for learned helplessness? Age Ageing 42:nn29

    Google Scholar 

  • Meijer A, Conradi HJ, Bos EH, Anselmino M, Carney RM, Denollet J, Doyle F, Freedland KE, Grace SL, Hosseini SH, Lane DA, Pilote L, Parakh K, Rafanelli C, Sato H, Steeds RP, Welin C, De Jonge P (2013) Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis. Br J Psychiatry 203(2):90–102

    Article  CAS  PubMed  Google Scholar 

  • Mirza SS, Wolters FJ, Swanson SA, Koudstaal PJ, Hofman A, Tiemeier H, Ikram MA (2016) 10-year trajectories of depressive symptoms and risk of dementia: a population-based study. Lancet Psychiatry 3:628

    Article  PubMed  Google Scholar 

  • Mojtabai R, Olfson M (2004) Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. Psychol Med 34(4):623–634

    Article  PubMed  Google Scholar 

  • Molyneux GJ, McCarthy GM, McEniff S, Cryan M, Conroy RM (2008) Prevalence and predictors of carer burden and depression in carers of patients referred to an old age psychiatric service. Int Psychogeriatr 20(6):1193–1202

    Article  CAS  PubMed  Google Scholar 

  • Mosca I, Barrett A (2016) The impact of voluntary and involuntary retirement on mental health: evidence from older Irish adults. J Ment Health Policy Econ 19(1):33–44

    PubMed  Google Scholar 

  • Naismith SL, Norrie LM, Mowszowski L, Hickie IB (2012) The neurobiology of depression in later-life: clinical, neuropsychological, neuroimaging and pathophysiological features. Prog Neurobiol 98(1):99–143

    Article  PubMed  Google Scholar 

  • Nelson JC, Delucchi K, Schneider LS (2008) Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence. Am J Geriatr Psychiatry 16(7):558–567

    Article  PubMed  Google Scholar 

  • NICE (2009) Depression: the NICE guideline on the treatment and management of depression in adults. Update Edition. Internet

    Google Scholar 

  • Nolen-Hoeksema S, Ahrens C (2002) Age differences and similarities in the correlates of depressive symptoms. Psychol Aging 17(1):116–124

    Article  PubMed  Google Scholar 

  • Olin JT, Schneider LS, Katz IR, Meyers BS, Alexopoulos GS, Breitner JC, Bruce ML, Caine ED, Cummings JL, Devanand DP, Krishnan KRR, Lyketsos CG, Lyness JM, Rabins PV, Reynolds Iii CF, Rovner BW, Steffens DC, Tariot PN, Lebowitz BD (2002) Provisional diagnostic criteria for depression of Alzheimer disease. Am J Geriatr Psychiatry 10(2):125–128

    Article  PubMed  Google Scholar 

  • Paradiso S, Duff K, Vaidya JG, Hoth A, Mold JW (2010) Cognitive and daily functioning in older adutls with vegetative symptoms of depression. Int J Geriatr Psych 25(6):569-577

    Google Scholar 

  • Ramos-Garcia MI, González-Salazar CF (2013) Electroconvulsive therapy: is there a role for treating older patients? Rev Clin Gerontol 23(4):283–294

    Article  Google Scholar 

  • Reinjders JSAM, Ehrt U, Weber WEJ, Aarskand D, Leentjens AFT (2008) A systematic review of prevalence studies of depression in Parkinson’s disease. Movement Disorders 23(2):183–189

    Google Scholar 

  • Robinson RG, Spalletta G (2010) Poststroke depression: A review. Can J Psychiat 55(6):341–349

    Google Scholar 

  • Roose SP, Nelson JC, Salzman C, Hollander SB, Rodrigues H (2003) Open-label study of mirtazapine orally disintegrating tablets in depressed patients in the nursing home. Curr Med Res Opin 19(8):737–746

    Article  PubMed  Google Scholar 

  • Schoevers RA, Smit F, Deeg DJH, Cuijpers P, Dekker J, Van Tilburg W, Beekman ATF (2006) Prevention of late-life depression in primary care: do we know where to begin? Am J Psychiatry 163(9):1611–1621

    Article  PubMed  Google Scholar 

  • Semkovska M, McLoughlin DM (2010) Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry 68(6):568–577

    Google Scholar 

  • Semkovska M, Landau S, Dunne R, Kolshus E, Kavanagh A, Jelovac A, Noone M, Carton M, Lambe S, McHugh C, McLoughlin DM (2016) Bitemporal versus high-dose unilateral twice-weekly electroconvulsive therapy for depression (EFFECT-Dep): a pragmatic, randomized, non-inferiority trial. Am J Psychiatr 173(4):408–417

    Google Scholar 

  • Sheline YI, Pieper CF, Barch DM, Welsh-Boehmer K, McKinstry RC, MacFall JR, D’Angelo G, Garcia KS, Gersing K, Wilkins C, Taylor W, Steffens DC, Krishnan RR, Doraiswamy PM (2010) Support for the vascular depression hypothesis in late-life depression: Results of a 20site, prospective, antidepressant treatment trial. Arch Gen Psychiat 67(3):277–285

    Google Scholar 

  • Sjösten N, Kivelä SL (2006) The effects of physical exercise on depressive symptoms among the aged: a systematic review. Int J Geriatr Psychiatry 21(5):410–418

    Article  PubMed  Google Scholar 

  • Skoog I, Waern M, Duberstein P, Blennow K, Zetterberg H, Börjesson-Hanson A, Östling S, Guo X, Kern J, Gustafson D, Gudmundsson P, Marlow T, Kern S (2015) A 9-year prospective population-based study on the association between the APOE∗E4 allele and late-life depression in Sweden. Biol Psychiatry 78(10):730–736

    Article  CAS  PubMed  Google Scholar 

  • Steffens DC, Nelson JC, Eudicone JM, Andersson C, Yang H, Tran QV, Forbes RA, Carlson BX, Berman RM (2011) Efficacy and safety of adjunctive aripiprazole in major depressive disorder in older patients: a pooled subpopulation analysis. Int J Geriatr Psychiatry 26(6):564–572

    Article  PubMed  Google Scholar 

  • Steunenberg B, Beekman ATF, Deeg DJH, Kerkhof AJFM (2010) Personality predicts recurrence of late-life depression. J Affect Disord 123(1–3):164–172

    Article  PubMed  Google Scholar 

  • Sweet RA, Hamilton RL, Butters MA, Mulsant BH, Pollock BG, Lewis DA, Lopez OL, DeKosky ST, Reynolds ICF (2004) Neuropathologic correlates of late-onset major depression. Neuropsychopharmacology 29(12):2242–2250

    Article  PubMed  Google Scholar 

  • Taylor WD (2014) Depression in the elderly. N Engl J Med 371(13):1228–1236

    Article  CAS  PubMed  Google Scholar 

  • Taylor WD, Aizenstein HJ, Alexopoulos GS (2013) The vascular depression hypothesis: mechanisms linking vascular disease with depression. Mol Psychiatry 18(9):963–974

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Van Schaik AM, Comijs HC, Sonnenberg CM, Beekman AT, Sienaert P, Stek ML (2012) Efficacy and safety of continuation and maintenance electroconvulsive therapy in depressed elderly patients: a systematic review. Am J Geriatr Psychiatr 20(1):5–17

    Article  Google Scholar 

  • Von Hippel W, Vasey MW, Gonda T, Stern T (2008) Executive function deficits, rumination and late-onset depressive symptoms in older adults. Cogn Ther Res 32(4):474–487

    Article  Google Scholar 

  • Waern M, Rubenowitz E, Wilhelmson K (2003) Predictors of suicide in the old elderly. Gerontology 49(5):328–334

    Article  PubMed  Google Scholar 

  • Whyte EM, Mulsant BH, Rovner BW, Reynolds CF (2006) Preventing depression after stroke. Int Rev Psychiatry 18(5):471–481

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mercer’s Institute for Successful Ageing, St. James’s Hospital and Trinity College, Dublin, Ireland

    C. Power, E. Greene & B. A. Lawlor

  2. Department of Psychiatry, Trinity College Dublin, Dublin, Ireland

    C. Power & B. A. Lawlor

  3. Department of Psychiatry, St James’s Hospital, Dublin, Ireland

    E. Greene & B. A. Lawlor

  4. Institute of Neuroscience, Trinity College, Dublin, OH, USA

    B. A. Lawlor

Authors
  1. C. Power
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Greene
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. A. Lawlor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Power .

Editor information

Editors and Affiliations

  1. The Chinese University of Hong Kong, Tai Po, Hong Kong

    Helen Chiu

  2. Sunnybrook Research Institute, Toronto, Ontario, Canada

    Kenneth Shulman

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Science+Business Media Singapore

About this entry

Cite this entry

Power, C., Greene, E., Lawlor, B.A. (2017). Depression in Late Life: Etiology, Presentation, and Management. In: Chiu, H., Shulman, K. (eds) Mental Health and Illness of the Elderly. Mental Health and Illness Worldwide. Springer, Singapore. https://doi.org/10.1007/978-981-10-2414-6_10

Download citation

Publish with us

Policies and ethics

Search

Navigation