What’s the difference between feeling sad and being depressed?

Clinical depression is a chronic, disabling medical condition.  Although fewer seniors may suffer from depression than younger people do, they are less likely to recognize their symptoms as depression and seek treatment. In fact, the risk of having untreated depression actually increases as we age.  At least one in twenty seniors will be suffering from symptoms that meet the clinical criteria for depression…and often they won’t even realize it.

Feeling sad and being depressed are not the same, although we often use these terms interchangeably. Depression is a clinical disorder, distinct from sadness or grief. Although clinical depression does involve periods of feeling sad or low, other symptoms include:

• reduced energy
• inability to concentrate
• difficulty sleeping
• loss of appetite
• lack of sexual interest
• withdrawal from social activities

As we age, these symptoms may become more prominent than, or emerge before, mood changes, making it difficult to pick up on the underlying depression.  As we get older, too, we lose loved ones and experience pain and sadness – but grief and depression aren’t the same thing.

Learn the distinctions

Grief is a normal human response to a painful event that requires support, not treatment. Depression, however, involves chemical imbalances in the brain that affect emotion and thought patterns in ways that limit our ability to function. Grief involves feeling bad on bad days; depression involves feeling bad even on good days.  The line blurs for people who take a very long time to recover from loss and resume their daily lives. They may be suffering from complicated grief, a depression-like condition that is also treatable when recognized.

It’s better to learn the distinctions between sadness, mourning, complicated grief, and clinical depression, rather than lumping everyone into a catch-all ‘depressed’ bucket.  That can help determine the best course of action and treatment. Here’s the catch: that requires talking about symptoms…and many seniors don’t or won’t. 

The Trouble with TLI 

We live in an era of over-sharing, of “TMI” (too much information).  Many seniors, though, do the opposite, with “TLI” (too little information), particularly when it comes to sharing emotional burdens. It could be due to stoicism  (“I’ll get over it”), reluctance to impose on family members (“I don’t want to burden them with my troubles”), or the mistaken belief that it’s natural (“I’m just getting old” ).  Many seniors are ashamed to speak up, especially those who came of age when talking about mental health wasn’t the norm. This is even more the case for seniors from some minority communities, where mental illness is still viewed with dishonor, and among senior males, who are more likely to dismiss their symptoms as unmanly or a sign of weakness.  

…if you think you have depression

I’m not advocating that having a sad day here or there should send us running to the doctor’s office. Moods come in many flavors!  We don’t want to pathologize every normal variation in human emotion.

But if you’ve been feeling down, particularly for an extended time, there’s nothing to lose by asking for help.  The symptoms may be attributable to something specific —  the loss of a loved one, a medication taken at the wrong dose or time of day, hearing loss or hearing aids that aren’t working properly, or even a bad mattress interfering with proper sleep.  The symptoms could also be more organic, coming from chemical imbalances in the brain.

The Good News: It’s vital to recognize and treat depression as we age. Untreated symptoms cause distress, reduce quality of life, can worsen outcomes for conditions such as heart disease and stroke…and can even shorten lifespans. The good news is that it is treatable, through a range of medications or behavioral therapies – just take the first step. You can talk to your primary care physician, nurse, social worker, or psychiatrist. If you don’t have one, below are some resources to help. 

Resources

To those interested in learning more about depression in Seniors, the Geriatric Mental Health Foundation https://www.aagponline.org/index.php?src=gendocs&ref=depression&category=Foundation has excellent resources, including guidance in locating a geriatric psychiatrist https://www.aagponline.org/index.php?src=membership&srctype=membership_lister_foundation. The Medicare website https://www.medicare.gov/physiciancompare/also offers guidance in locating providers in your area who accept Medicare plans. 

For those living in New York area, New York City has a service program for older adults that includes a range of programs on mental and behavioral health for seniors at https://www.spop.org/. Columbia University also has a free clinical service on aging and depression that provides detailed evaluations and referrals https://www.columbiapsychiatry.org/research-clinics/clinic-aging-anxiety-and-mood-disorders-caam-formerly-adult-and-late-life

This article is for informational purposes and is not a replacement for medical advice from your physician. 

Ardesheer Talati, Ph.D.  is an Associate Professor of Clinical Neurobiology in Psychiatry at Columbia University Vagelos College of Physicians and Surgeons and a Research Scientist at New York State Psychiatric Institute.