As crippling as depression can be for young and middle-age adults, it's truly severe in the elderly, and more often fatal. And while depression and related illnesses afflict 20 percent of America's elderly, only a fraction are getting the treatment they need.
"Depression kills not just through suicide," says Barry Lebowitz, director of treatment research at the National Institute of Mental Health. "[Elderly] people can be so debilitated by depression that they are not managing their hypertension or diabetes or they are not eating right. People die from the sort of excess disability that is created by depression in the context of other diseases."
Contrary to conventional wisdom, depression is not a normal part of aging. But certain aspects of depression do become more distinctive with age. For one thing, the elderly may have different symptoms than younger patients.
"Older people will basically agree that they're experiencing every symptom of depression except depression," Lebowitz says.
Experts often refer to this as "depression without sadness." A person may complain that his food doesn't taste good, that he's not sleeping and that he is having trouble remembering things and making decisions.
Memory and other cognitive problems may combine to make the person seem to have dementia, says Dr. Howard Berkowitz, director of the consultation and emergency psychiatry service at Maimonides Medical Center in New York City. "The person may also look apathetic rather than overtly depressed and is likely to deny he or she is depressed," he says.
Risk factors are also often different for older people. Also, people who aren't elderly -- including caregivers and family members -- tend to miss signs of depression in older individuals, thinking it's normal to feel that way at that age.