Depression (mate pāpouri) is a state of persistent and ongoing unhappiness. It can develop in later life, but is not part of the aging process. If you have ongoing feelings of low mood (wainuku), sadness (pōuritanga), hopelessness and loss of interest in life, talk with your doctor. The sooner you get help, the sooner you will start to feel better.
- Depression in later life is a type of depression that occurs after the age of 65. It is more than an ‘attack of the blues’ or being ‘in the doldrums’ for a short while. Depression is a state of persistent and ongoing unhappiness. Māori may describe this as wainuku and whakamamae.
- Many older people experience depression, but it often is undiagnosed and untreated. Depression and physical illness can both be factors in suicide for older adults. Men 85 years and above have one of the highest suicide rates in New Zealand.
- Older adults often report more physical (tinana) symptoms than the psychological (hinengaro) symptoms associated with depression. Your doctor may mistake these physical symptoms as part of the ageing process, which means you may not get accurately diagnosed with depression.
- Tell your doctor if you have constant feelings of low mood/wainuku for more than two weeks. Early diagnosis and treatment increase your chances of recovery.
- Treatment options for depression include talk therapy, medication and traditional medicine such as rongoā Māori. Lifestyle measures also help, such as regular exercise (eg, gardening, walking), contact with friends and whānau, hobbies or voluntary work.
Who is at risk of later-life depression?
Older people face a number of unique challenges – significant lifestyle changes, such as bereavement, retirement and loss of independence, and development of physical and mental conditions.
This can lead to feelings of grief, loss and loneliness, and these as well as poverty, illness and reaction to medicines can increase your risk of developing depression in later life.
However, experiencing depression is not a part of the ageing process. Many older adults find meaning and purpose in their life and don’t struggle with depression.
People over 65 years of age who are more at risk of depression include those who have:
- had a previous episode of depression
- a family history of depression or suicide attempts
- misuse of alcohol or other substances
- had childhood trauma
- responsibilities for caring for others
- chronic or severe physical illness
- experienced grief or loss.
Onset of depression in later life may be a risk factor for or an early sign of dementia.
How is depression different from grief?
The signs of depression and grief can be similar. A key difference is the sadness of grief compared with the numbness or almost non-feeling state of depression.
Grieving is a natural process that lessens over time. If you have persistent low mood and feelings of hopelessness, which continue for months after a bereavement or loss, talk to your doctor.
What are the symptoms of later-life depression?
Older adults often report more physical symptoms (aches, pains, fatigue, slowness, difficulty concentrating and irritability) than the psychological ones (hopelessness, low mood, despair, negative thinking and worthlessness) associated with depression.
Here are symptoms to look out for:
- aches and pains that don't go away
- avoidance of regular activities
- feeling sad all the time
- difficulty concentrating
- eating more or less than usual
- feeling helpless or hopeless
- inability to focus or make decisions
- irritability or agitation
- lack of energy
- loss of interest in things and/or people
- slowness of movements or speech
- socially withdrawn or isolated
- sleeping difficulties
- thoughts of death or suicide.
These are possible indicators of depression. They may also be signs of a physical illness. If you or an older adult you know experiences these symptoms for more than 2 weeks, see your doctor.
The earlier diagnosis is made and treatment begins, the better your chances of recovery and a return to your usual activities and enjoyment of life.
Why is depression often not recognised in older people?
Depression is often missed as an illness in older adults. This may be because older adults often report more physical complaints than the psychological ones we often associate with depression. These physical pains may be mistakenly thought to be part of the ageing process, resulting in older adults not getting accurately diagnosed with depression.
Some older people go to the doctor regularly for physical aches and pains or because they are lonely, and don’t recognise that this may be depression.
Other factors include:
- reluctance to ‘bother’ your GP about something other than a physical illness
- not mentioning depression and being more likely to talk about vague symptoms
- having difficulty putting troubled feelings into words
- men having more difficulty recognising and accepting emotions related to depression
- having endured WWII and economic depression and learned to 'keep your chin up' and carry on without complaining
- finding it hard to accept that counselling can help when you are depressed
- having memories of people being placed in asylums and being subjected to treatment without their consent
- already taking medication and not wishing to take more.
How is depression treated?
Treatment for depression may include a combination of talk therapy, lifestyle changes and/or taking medication – usually an antidepressant. There are also tohunga or healers in your communities you can go to for rongoā Māori services. For some people, alternative approaches have been useful, such as mindfulness meditation, St John's wort and online tools and courses. Learning about self-care, and knowing how to access support and find someone to talk to when you need, can make a huge difference too.
Talk therapy (counselling or psychotherapy)
A number of psychotherapy (talk therapy) approaches have been found to be helpful with depression, such as cognitive behaviour therapy (CBT). CBT is a well-regarded therapy for depression and may be of benefit by helping you to think more positively. You can ask your GP to recommend someone or find a counsellor yourself.
Learn more about talk therapy.
Looking after your physical health is an important way to improve your mental health. Improvements to four aspects of your daily life can greatly reduce your depression: sleep, exercise, diet and the use of alcohol or other recreational drugs. If you do not exercise regularly, ask your GP about a green prescription.
Learn more about lifestyle changes.
Antidepressants are generally reserved for people with moderate to severe depression, where psychological therapy and lifestyle changes have not been enough for the depression to go away. They work best when used together with psychological therapy and lifestyle changes.
If you are prescribed medication ask your doctor:
- the medication name
- what symptoms it is treating
- how long it will be before it takes effect
- how long you have to take it for
- what the side effects are.
Sometimes, especially if you are feeling down, it is really hard to remember exactly what the doctor says. Consider having a supportive friend or family member accompany you.
Learn more about treatment for depression.
Rongoā Māori is a traditional Māori healing approach. It includes herbal or medicinal remedies (rakau rongoā), physical therapies that are similar to massage and manipulation (like mirimiri or romiromi), spiritual healing, karakia and pastoral support and whitiwhiti kōrero (cultural support).
Learn more about rongoā Māori services
Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri massage and aromatherapy have all been shown to have some effect in alleviating mental distress.
Learn more about alternative approaches.
Looking after yourself when you’re feeling down
Many older people have developed strategies for dealing with times when they feel down. These include gardening, walking on the beach, visiting grandchildren, reading a good book, phoning friends or treating yourself to a small luxury.
These things sometimes drive the blues away, but some people can disguise depression by making themselves busy and not getting the help they need.
You may find it helps you to use your voice and your vote to influence people's attitudes and change social factors like poverty that contribute to depression. You may also find comfort and meaning in spirituality or religious beliefs. These are all things that protect you from depression or help you make a successful recovery from it.
Learn more about living well with depression.
Friends and whānau
Friends and whānau can be good medicine and having meaningful contacts with others is of real value by engaging more in social activities. You may find that doing things you enjoy, hobbies or voluntary work contribute to a sense of worth and belonging in a community.
See more ways to wellbeing for over 55s
Change and letting go
Understanding the context of aging may be helpful. Where aging is also about taking on and accepting new and different roles whereby you may not be as actively included in the community as you once were. Change and letting go is a normal process but may at times be hard and sometimes painful. Self-compassion and acceptance approaches regarding these new roles may be useful for some people.
Learn more about self-compassion
Your identity can play a big role in your wellbeing. This can be influenced by your culture, where you live (ie, rural or urban), your sexuality or other factors such as being deaf or blind. For some groups, there will be shared challenges that contribute to their experiences of distress. And there are also some shared ways of getting through the hard times to enjoy life again.
Learn more about identity and depression
Need someone to talk to?
If you are affected by depression, it can help to have someone to talk to. You can start with your doctor or one of the following free helplines:
- 1737 phone or text 24/7 to reach a trained counsellor
- Depression Helpline (0800 111 757)
- Lifeline (0800 543 354)
- Samaritans (0800 726 666)
Trusted mental health information Mental Health Foundation, NZ
Find out how to tell if someone is struggling with their mental health BBC, UK, 2021
Expert information and support in response to elderly needs Age Concern, NZ
Supporting families towards mental wellbeing Yellow Brick Road, NZ
Depression resources, chat and much more depression.org.nz
The Journal – online self-help programme depression.org.nz
Mental health crisis assessment teams (for emergencies only)
Just a thought NZ
Small Steps NZ
|Tina Earl is a clinical psychologist with over 20 years’ experience, currently in private practice and consultancy. She has been a clinical lead for psychological services in the DHB and primary care. Tina has authored resources at a national level for mental health clinical practice and service delivery and is a subject matter consultant for psychological practice and mental health.