Depression is a medical illness in which a person has feelings of sadness, discouragement, and a lack of self-worth.

Depression can be caused by the loss of a spouse or close friend, chronic pain and illness, difficulty getting around, frustration with memory loss, trouble adapting to a life change such as moving from a home to a retirement facility, or changes within the family.

Depression can also be a sign of a medical problem. It may be complicated by brain disorders that occur with age, such as Alzheimer's disease.

Depression in the elderly is a widespread problem that is often not diagnosed and frequently undertreated. Many older people will not admit to the signs and symptoms of depression, for fear that they will be seen as weak or crazy.

Symptoms of depression include:

• Depressed or irritable mood
• Feelings of worthlessness or sadness
• Loss of interest or pleasure in daily activities
• Temper, agitation
• Change in appetite (usually a loss of appetite)
• Change in weight
  • Unintentional weight loss (most common)
  • Weight gain
• Trouble sleeping
  • Daytime sleepiness
  • Difficulty falling asleep (initial insomnia)
  • Waking up many times through the night (middle insomnia)
  • Waking up early in the morning (terminal insomnia)
• Fatigue (tiredness or weariness)
• Aches and pains
• Difficulty concentrating
• Memory loss
• Abnormal thoughts, excessive or inappropriate guilt
• Irresponsible behavior
• Abnormal thoughts about death
• Thoughts about suicide
• Plans to commit suicide or actual suicide attempts

If you have these symptoms every day for more than 2 weeks, you likely have depression.

Depression in the elderly may be hard to detect because of several factors. Symptoms such as fatigue, appetite loss, and trouble sleeping also can be part of the aging process or a medical condition.

A physical exam will help determine if a medical illness is causing the depression. A psychological evaluation and other tests may be needed.

Blood tests may be done, including:

• CBC
• Blood differential
• Thyroid function tests
• Liver or kidney function tests