Growing old in the United States seems to be viewed by many in modern society as a sad and negative occurrence. Many institutions in our culture hold this perception especially media and advertising, where the experience of the elderly is distorted and discounted, if represented at all. The message seems to be that you must be young to be worthwhile.

It is estimated that in less than thirty years, older adults will account for 20 percent of the population, up from 13 percent today. Currently 20 percent of Americans 55 or older experience a mental illness, with evidence showing that occurrences of these illness may be "underreported." Suicide occurs at a higher rate for older adults than any other age group. 

For older persons, symptoms of mental illness often differ from those experienced by younger persons, making accurate diagnosis and treatment difficult (9). Even mild problems may interfere with independent functioning, given the increased likelihood of physical illness or social isolation (11). Further, ageism and stigma are serious issues affecting this population and the development of services required to meet their complex and ever-changing needs (12). 

Being "down in the dumps" over a period of time is not a normal part of growing old. But it is a common problem, and medical help may be needed. For most people, depression can be treated successfully. "Talk" therapies, drugs, or other methods of treatment can ease the pain of depression.

There are many reasons why depression in older people is often missed or untreated. As a person ages, the signs of depression are much more likely to be dismissed as crankiness or grumpiness. Depression can also be tricky to recognize. Confusion or attention problems caused by depression can sometimes look like Alzheimer's disease or other brain disorders. Mood changes and signs of depression can be caused by medicines older people may take for high blood pressure or heart disease. Depression can happen at the same time as other chronic diseases. It can be hard for a doctor to diagnose depression, but the good news is that people who are depressed can get better with the right treatment. 

Some older people themselves believe that mental health disorders and treatment are shameful, represent a personal failure, or will lead to a loss of autonomy. They may thus deny having mental health problems or refuse treatment. If there is concern that an older adult is exhibiting symptoms of depression, the first step to getting help is to accept that help is needed. The subject of mental illness still makes some people uncomfortable. Some feel that getting help is a sign of weakness. Many older people, their relatives, or friends may believe, mistakenly, that a depressed person can quickly "snap out of it" or that some people are too old to be helped.

Once the decision is made to get medical advice, start with the family doctor. The doctor should check to see if there are medical or drug-related reasons for the depression. After a complete exam, the doctor may suggest talking to a mental health specialist. The special nature of depression in older people has led to a new medical specialty: geriatric psychiatry.

Be aware that some family doctors may not understand aging and depression. They may not be interested in these complaints. Or, they may not know what to do. If your doctor is unable or unwilling to take your concerns about depression seriously, you may want to consult a psychologist or another health care provider.

If a depressed older person won't go to a doctor for treatment, relatives or friends can help. They can explain how treatment may help the person feel better. In some cases, when an older person can't or won't go to the doctor, the family can start by making a phone call. The telephone can't take the place of the personal contact needed for a complete medical checkup, but it can break the ice.

Don't avoid getting help because you are afraid of how much treatment might cost. Short-term psychotherapy, with or without medication, will work in many cases. It is often covered by insurance. Medicare covers most in- and outpatient mental health treatment. Also, community mental health centers offer treatment based on a person's ability to pay.