Everyone feels blue or sad now and then, but these feelings don't usually last long and pass within a couple of days. When a person has depression, it interferes with daily life and normal functioning, and causes pain for both the person with depression and those who care about him or her. Doctors call this condition "depressive disorder," or "clinical depression."

Important life changes that happen as we get older may cause feelings of uneasiness, stress, and sadness. For instance, the death of a loved one, moving from work into retirement, or dealing with a serious illness can leave people feeling sad or anxious. After a period of adjustment, many older adults can regain their emotional balance, but others do not and may develop depression.

Depression is a common problem among older adults, but it is NOT a normal part of aging. In fact, studies show that most older adults feel satisfied with their lives, despite having more physical ailments. However, when older adults do suffer from depression, it may be overlooked because they may be less willing to talk about feelings of sadness or grief, and doctors may be less likely to suspect or spot it.

Of the 35 million Americans age 65 and older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness. If left untreated, depression can lead to suicide.

It is widely believed that suicide more often affects young people, but older adults are affected by suicide, too. Of the roughly 30,000 suicide deaths in the United States in 2004, adults age 65 and older accounted for about 16 percent of them. In fact, non-Hispanic white men age 85 and older have the highest suicide rate in the United States.

There are several types of depression. The most common types are major depressive disorder and dysthymic disorder.

Major depressive disorder, also called major depression or clinical depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy activities he or she once liked. Major depression prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.

Dysthymic disorder, also called dysthymia, is a less severe but more long-lasting form of depression. Dysthymia is characterized by symptoms lasting two years or longer that keep a person from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetime.

Common among older adults is "subsyndromal depression" -- less severe but clear symptoms of depression that fall short of being major depression or dysthymia. Having subsyndromal depression may increase a person's risk of developing major depression.

1. Depression is

2. Depression is

3. Of the 35 million Americans age 65 and older,

4. Dysthymia is

Neuroscience, genetics, and other research studies have shown that depressive illnesses are disorders of the brain. But the exact causes for these illnesses are not yet clear and are still being studied.

Imaging technologies such as magnetic resonance imaging (MRI) scans show that the brains of people with depression look different than those of people without the illness. The scans show that the areas of the brain that control moods, thinking, sleep, appetite, and behavior are not functioning properly. The scans also reveal imbalances in important brain chemicals called neurotransmitters that allow brain cells to communicate with each other. But these images do not yet reveal WHY the depression has occurred.

In general, there is no one cause or risk factor for depression. It most likely results from many factors, such as family history, life experiences, and environment. Older adults with depression may have had it when they were younger, or they may have a family history of the illness. They may also be going through difficult life events, such as losing a loved one, a difficult relationship with a family member or friend, or financial troubles.

For older adults who experience depression for the first time later in life, other factors may be at play. Depression may be related to changes that occur in the brain and body as a person ages. For example, older adults may suffer from restricted blood flow, a condition called ischemia. Over time, blood vessels may harden and prevent blood from flowing normally to the body's organs, including the brain.

If this happens, an older adult with no family history of depression may develop what some doctors call "vascular depression." Those with vascular depression also may be at risk for other vascular illnesses, such as heart disease, or stroke.

Depression can also co-occur with other serious medical illnesses such as diabetes, cancer, and Parkinson's disease. Depression can make these conditions worse, and vice versa. Sometimes, medications taken for these illnesses may cause side effects that contribute to depression.

Because many older adults face these illnesses along with various social and economic difficulties, some health care professionals may wrongly conclude that these problems are the cause of the depression -- an opinion often shared by patients themselves.

All these factors can cause depression to go undiagnosed or untreated in older people. Yet, treating the depression will help an older adult better manage other conditions he or she may have.

1. Depression is a disorder of

2. Depression likely is a result of

3. Vascular depression may occur when

4. Which of the following medical conditions often co-occur with depression?

There are many symptoms associated with depression, and some will vary depending on the individual. However, some of the most common symptoms are listed below. If you have several of these symptoms for more than two weeks, you may have depression.

• feeling nervous or emotionally "empty"
• feelings of excessive guilt or worthlessness
• tiredness or a "slowed down" feeling
• restlessness and irritability

Common symptoms of depression:

• feeling like life is not worth living
• sleep problems, including trouble getting to sleep, wakefulness in the middle of the night, or sleeping too much
• eating more or less than usual
• having persistent headaches, stomach-aches or other chronic pain that does not go away when treated

Common symptoms of depression:

• loss of interest in once pleasurable activities, including sex
• frequent crying
• difficulty focusing, remembering or making decisions
• thoughts of death or suicide, or a suicide attempt

The first step to getting appropriate treatment is to visit a doctor. Certain medications taken for other medical conditions, vitamin B12 deficiency, some viruses, or a thyroid disorder can cause symptoms similar to depression. If an older adult is taking several medications for other conditions and is depressed, seeing a doctor is especially important.

A doctor can rule out medications or another medical condition as the cause of the depression by doing a complete physical exam, interview, and lab tests. If these other factors can be ruled out, he or she may refer you to a mental health professional, such as a psychologist, counselor, social worker, or psychiatrist. Some doctors called geriatric psychiatrists are specially trained to treat depression and other mental illnesses in older adults.

The doctor or mental health professional will ask about the history of your symptoms, such as when they started, how long they have lasted, their severity, whether they have occurred before, and if so, whether they were treated and how. He or she will then diagnose the depression and work with you to choose the most appropriate treatment.

1. Symptoms of depression include

2. Depression sometimes can be caused by

3. If you feel you may have depression, you should

Depression, even in its most severe form, is highly treatable. As with many illnesses, getting treatment early is more effective and reduces the chance of recurrence. And because it often co-occurs with other illnesses in older adults, untreated depression may delay recovery from or worsen the outcome of other illnesses. It is important to remember that a person with depression cannot simply "snap out of it."

Treatment choices differ for each person, and sometimes different treatments must be tried until one works for a particular person. It is important to keep trying until you find something that works for you.

The most common forms of treatment for depression are medication and psychotherapy.

Medications called antidepressants work to normalize brain chemicals called neurotransmitters, notably serotonin, norepinephrine, and dopamine. Scientists studying depression have found that these chemicals, and possibly others, are involved in regulating mood, but they are unsure of exactly how they work.

The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). SSRIs include fluoxetine (Prozac), citalopram (Celexa) and several others. SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta). Another newer antidepressant that is different from both SSRIs and SNRIs but is very popular is bupropion (Wellbutrin). These newer drugs are more popular than the older classes of antidepressants, such as tricyclics and monoamine oxidase inhibitors (MAOIs), because they tend to have fewer side effects. However, medications affect everyone differently. Therefore, for some people, tricyclics or MAOIs may be the best choice.

People taking MAOIs must follow strict food and medicine guidelines to avoid potentially serious interactions. They must avoid substances that contain high levels of the chemical tyramine which is found in many cheeses, wines, and pickles and in some medications including decongestants. MAOIs interact with tyramine in a way that may cause a sharp rise in blood pressure, possibly leading to a stroke. A doctor should give a patient taking an MAOI a complete list of foods, medicines, and substances to avoid.

For all types of antidepressants, patients must take regular doses for at least three to four weeks, sometimes longer, before they are likely to feel the full benefit. They should continue taking the medication for an amount of time specified by their doctor, even if they are feeling better, to prevent the depression from returning.

Stopping medication should be done only under a doctor's supervision. They need to be gradually stopped to give the body time to adjust. Although they are not habit-forming or addictive, antidepressants should not be stopped abruptly because that can cause withdrawal symptoms or lead to a relapse. Some people, such as those whose depression is chronic or keeps returning, may need to stay on the medication for a long time.

Older adults who are experiencing their first episode of depression also may want to stay on antidepressant medication for a while, even if their symptoms have disappeared. Recent research shows that patients age 70 and older who took antidepressant medication for two years after they became symptom-free were 60 percent less likely to experience a relapse than those who stopped taking the medication.

If one medication does not work, patients should be willing to try another. Research has shown that patients who do not get well after taking a first medication increase their chances of getting well after switching to a different medication or adding another medication to their first one.

The most common side effects of antidepressant medications include headache, nausea, insomnia or nervousness, agitation or a jittery feeling, and sexual problems. Often they are mild and temporary. However, any unusual reactions or side effects that interfere with normal functioning should be reported to a doctor immediately.

For older adults who are already taking several medications for other conditions, it is important to talk with a doctor about any adverse drug interactions that may occur while taking antidepressants.

In some rare cases, antidepressant medications may lead to suicidal thoughts or actions. However, there is no evidence that they may have this unintended effect among older adults.

In addition to antidepressants, some people use the herb St. John's wort to treat depression. A bushy, wild-growing plant with yellow flowers, the herb has been used for centuries in many folk and herbal remedies. Today in Europe, it is widely used to treat mild to moderate depression. In the United States, it is one of the top-selling botanical products.

The National Institutes of Health recently conducted a clinical trial to find out if the herb was effective in treating adults suffering from major depression. (A clinical trial is a research study with people to find out if a drug, treatment, or therapy is safe and effective.) The trial found that St. John's wort was no more effective than a placebo, or sugar pill, in treating major depression. Another study is looking at the effectiveness of St. John's wort for treating mild or minor depression.

Other research has shown that St. John's wort can interact unfavorably with other drugs. On February 10, 2000, the FDA issued a Public Health Advisory stating that the herb appears to interfere with certain drugs used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. Because of these potential interactions, older adults should always consult with their doctors before taking any herbal supplement.

1. The most popular kinds of antidepressant medications used today are called

2. Antidepressant medications will lift your depression

3. Possible side effects of antidepressant medications include

4. An herbal supplement sometimes used to treat depression is called

Several types of psychotherapy -- or "talk therapy" -- can help people with depression. Some treatments are short-term, lasting 10 to 20 weeks, and others are longer, depending on the person's needs.

Two main types of psychotherapies -- cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) -- have been shown to be effective in treating depression.

By teaching new ways of thinking and behaving, CBT (cognitive-behavioral therapy) helps people change negative habits that may contribute to their depression. IPT (interpersonal therapy) helps people understand and work through troubled personal relationships or events that may cause their depression or make it worse.

For mild to moderate depression, psychotherapy may be the best treatment option. However, sometimes psychotherapy alone is not enough. A study examining depression treatment among older adults found that patients who got better with medication and IPT were less likely to have the depression return if they continued their combination treatment for at least two years.

1. A type of psychotherapy that helps people learn new ways of thinking and behaving is called

2. A type of therapy that can help people understand and work through troubled relationships or events is called

3. For mild depression, the best treatment is often

When medication and/or psychotherapy does not help improve a person's depression, electroconvulsive therapy (ECT) sometimes is used. ECT, once known as "shock therapy," used to have a very bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not gotten better or improved with other treatments.

Before electroconvulsive therapy is given, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse from ECT. A patient typically will have ECT several times a week, and often will also need to take an antidepressant or mood stabilizing medication to prevent the depression from returning. Although some patients will need only a few courses of ECT, others may need follow-up treatments, usually once a week at first, then gradually decreasing to monthly for up to one year.

Electroconvulsive therapy may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear up soon after treatment.

1. When medication or psychotherapy are not effective treatments for depression, doctors sometimes recommend

2. During electroconvulsive therapy, a person

3. Electroconvulsive therapy (ECT) may cause some short-term side effects such as

Studies show that about 80 percent of older adults with depression improve when they receive treatment with an antidepressant, psychotherapy or a combination of both. Moreover, treating depression in older adults often improves the outcomes of co-existing medical conditions, a relationship that is the focus of much ongoing research.

However, there are some special considerations that doctors must take into account when treating older adults. The commonly prescribed medications for depression may not work well for some older adults because they may interact unfavorably with other medications being taken for other conditions. Some older adults with depression may also have some problems thinking clearly, and these individuals often respond poorly to the drugs.

Research shows that, for older adults, a combination of medication and psychotherapy treatment is most effective in treating depression and reducing the number of new episodes. But for those older adults who are unable or unwilling to take medication, research shows that psychotherapy alone also can be effective in helping seniors with depression. Studies suggest that cognitive-behavioral therapy (CBT) may be an especially useful type of psychotherapy for treating older adults and improving their quality of life.

Despite progress in treatment research, late-life depression often goes undiagnosed or is inadequately treated in older adults. In fact, several studies have found that up to 75 percent of older adults who die by suicide had visited their primary care doctors within one month of their deaths.

Researchers are working to help both doctors and patients better recognize the signs of depression and the potential for suicide in older adults. To improve diagnosis, researchers funded by NIH's National Institute of Mental Health are studying the effectiveness of an education and intervention program targeted to primary care clinics and providers. The program aims to improve recognition and treatment of depression and suicidal symptoms in older patients.

Another study found that a comprehensive approach to care will lead to better treatment results. The Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) offered antidepressant medication and/or psychotherapy to depressed older adults, along with a "care manager" -- a social worker, nurse or psychologist -- who monitored their symptoms, side effects of medication, and progress.

The study found that those participants who had case-managed care got better more quickly, had longer periods without depression, and in general responded better to treatment than those who did not have case-managed care.

Finally, researchers are looking at the role hormone changes may play in the development of depression in older adults. They want to find out whether hormone replacement therapy with estrogens or androgens may benefit older adults with late-life depression. Other studies are looking to better understand the relationship between other medical illnesses and depression. Still others are looking to help older adults get better access to depression treatment. Findings from these and other studies will provide important information for doctors to treat late-life depression.

If you are in a crisis...

If you are thinking about harming yourself or attempting suicide, tell someone who can help immediately.

• Call your doctor.
• Call 911 for emergency services.
• Go to the nearest hospital emergency room.
• Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to be connected to a trained counselor at a suicide crisis center nearest you.

1. Research shows that

2. Among older adults, depression is often

3. The recent PROSPECT study (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) which offered antidepressant medication and/or psychotherapy to depressed older adults, found that participants who also had a care manager

4. If you are thinking about harming yourself or attempting suicide, you should

Depression is more than just feeling blue or sad. It is an illness. When you have depression, it interferes with daily life and normal functioning, and causes pain for both you and those who care about you.

If you have depression, you are not alone. Of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness.

Untreated depression can lead to suicide. Of the roughly 30,000 suicide deaths in 2004, adults age 65 and older accounted for about 16 percent of them. Non-Hispanic white men age 85 and older have the highest suicide rate in the United States.

Major depressive disorder, also called major depression or clinical depression, is characterized by a combination of symptoms that interfere with your ability to work, sleep, eat, and enjoy activities you once liked. Major depression keeps a person from functioning normally.

Dysthymic disorder, or dysthymia, is a less severe but sometimes more long-lasting form of depression. It is characterized by symptoms lasting two years or longer that keep you from functioning normally or feeling well.

Many older adults experience subsyndromal depression -- real symptoms of depression that are less severe than major depression or dysthymia. Having sybsydromal depression may increase your risk of developing major depression.

Imaging technologies show that the brains of people with depression look different than those who do not have the illness. The areas of the brain that control moods, thinking, sleep, appetite, and behavior appear not to be functioning well, and important brain chemicals are out of balance. But these images do not reveal WHY the depression has occurred.

The risk factors for depression are family history, life experiences, and environment. If you have depression, you may have experienced it when you were younger, and may have a family history of the illness. You may also be going through difficult life events, such as physical or psychological trauma, losing a loved one, a difficult relationship with a family member or friend, or financial troubles. Any of these stressful experiences can lead to depression.

If you experience depression for the first time later in life, other factors may be at play. Depression may be related to changes that occur in the brain and body as we age. For example, some older adults may suffer from restricted blood flow, a condition called ischemia. Over time, blood vessels harden and prevent blood from flowing normally to the body's organs, including the brain. If this occurs, an older adult with no family history of depression may develop what some doctors call "vascular depression."

Depression often co-occurs with heart disease and stroke. It can also co-occur with diabetes, cancer, Parkinson's disease, and other serious medical illnesses. Depression may make these conditions worse, and vice versa. Sometimes, medications taken for these illnesses can cause side effects that contribute to depression.

Symptoms of depression often vary depending on the person. Common symptoms include:

• feeling nervous or emotionally empty
• tiredness or a "slowed down" feeling
• feeling guilty or worthless

Common symptoms of depression:

• restlessness and irritability
• feeling like life is not worth living
• sleep problems such as insomnia, oversleeping or wakefulness in the middle of the night; eating more or less than usual
• having persistent headaches, stomach-aches or other chronic pain that does not go away when treated

Common symptoms of depression:

• loss of interest in once pleasurable activities
• frequent crying
• difficulty focusing, remembering or making decisions
• thoughts of death or suicide

First, visit a doctor. Talk to him or her about your symptoms, discuss any medications you are taking, and discuss any other medical conditions you may have. Certain medications taken for other medical conditions, a vitamin B12 deficiency, some viruses, or a thyroid disorder can cause the same symptoms as depression.

A doctor should give you a complete physical exam and do any lab tests to rule out the possibility that medications or another medical condition are causing your depression. If these can be ruled out, he or she may refer you to a mental health professional such as a psychologist, counselor, social worker, or psychiatrist.

The doctor or mental health professional will ask you about your symptoms, such as when they started, how long they have lasted, their severity, whether they have occurred before, and if so, whether were they treated and how. He or she then will diagnose the depression, and work with you to choose the most appropriate treatment.

Yes. Even the most severe cases of depression are highly treatable. As with many illnesses, getting treatment early is more effective and reduces the chance of recurrence. If you have other medical conditions, it is especially important to treat depression because having depression may delay recovery from or worsen the outcome of other illnesses.

Treatment choices differ for each person, and sometimes different treatments must be tried until one works for you. It is important not to give up. The most common forms of treatment for depression are medication and psychotherapy.

Medications called antidepressants work to control natural brain chemicals called neurotransmitters, which get out of balance when a person is depressed. Scientists studying depression have found that these chemicals are involved in regulating mood.

The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs). They include fluoxetine (Prozac), citalopram (Celexa) and several others. Similar to SSRIs are serotonin and norepinephrine reuptake inhibitors (SNRIs) and include venlafaxine (Effexor) and duloxetine (Cymbalta). Another newer antidepressant bupropion (Wellbutrin) is neither an SSRI nor an SNRI but is popular as well. Older antidepressants, called tricyclics and monoamine oxidase inhibitors (MAOIs), are still used sometimes, too.

SSRIs and SNRIs are more popular than the older classes of antidepressants because they tend to have fewer side effects. However, medications affect everyone differently so talk with your doctor to decide which type is best for you.

People taking MAOIs must follow strict food and medicine restrictions to avoid potentially serious interactions. If you take an MAOI, your doctor should give you a complete list of foods, medicines, and substances to avoid.

All antidepressant medications take several weeks to have an effect. You must take regular doses for at least three to four weeks, sometimes longer, before you are likely to feel the full benefit. You should continue taking the medication for the amount of time specified by your doctor, even if you are feeling better, to get the full effect and prevent the depression from returning.

Stopping medication should be done only under a doctor's supervision. They need to be gradually stopped to give the body time to adjust. Although they are not habit-forming or addictive, antidepressants should not be stopped abruptly because that can cause withdrawal symptoms or the depression may return. If your depression is chronic or keeps returning, you may need to stay on the medication for a long time.

If you are experiencing your first episode of depression, you also may want to stay on antidepressant medication for a while, even if your symptoms have disappeared. Recent research shows that patients age 70 and older who took antidepressant medication for two years after they became symptom-free were 60 percent less likely to experience a relapse than those who stopped taking the medication.

The most common side effects that antidepressant medications can cause are headache, nausea, insomnia or nervousness, agitation or a jittery feeling, and sexual problems. Often, the side effects are mild and temporary. However, if you have any unusual reactions or side effects that interfere with your normal functioning, you should report them to your doctor immediately.

If you are already taking several medications for other conditions, it is important to talk to your doctor about any potentially adverse drug interactions that may occur while taking antidepressants.

A bushy, wild-growing plant with yellow flowers, St John's wort has been used for centuries in many folk and herbal remedies. It is commonly used in Europe to treat mild depression, and it is a top-seller in the United States as well.

Recently, the National Institutes of Health conducted a clinical trial to determine the effectiveness of the herb in treating adults suffering from major depression. (A clinical trial is a research study with people to find out if a drug, treatment, or therapy is safe and effective.) The trial found that St. John's wort was no more effective than a placebo, or sugar pill, in treating major depression. Currently, another study is looking at the effectiveness of St. John's wort for treating mild depression.

Be sure to consult your doctor before taking St. John's wort, as it may interfere with other medications. On February 10, 2000, the Food and Drug Administration issued a Public Health Advisory stating that the herb may interfere with certain drugs used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection.

Psychotherapy can help older adults with depression who are unable or unwilling to take medication. Two main types of psychotherapies -- cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) -- are effective in treating depression. These therapies are sometimes called "talk therapies."

During CBT, a mental health professional will help you change negative ways of thinking and behaving that may contribute to your depression. During IPT, a mental health professional helps you understand and work through troubled personal relationships or events that may cause your depression or make it worse.

Sometimes treatment will include both medication and psychotherapy. Studies have shown that this combination treatment is highly effective in treating depression among older adults.

Electroconvulsive therapy (ECT), once known as "shock therapy," is sometimes used to treat severe depression that does not improve with medication and/or psychotherapy. ECT used to have a very bad reputation, but in recent years, it has improved a lot and can provide relief for people with severe depression when other treatments have failed.

If you have electroconvulsive therapy (ECT), you are first given a muscle relaxant and put under brief anesthesia. Painless electrical impulses are then given. Although some patients will only need a few courses of ECT, others may need follow-up treatments, usually once a week at first, then gradually decreasing to monthly for up to one year. Sometimes the doctor may ask you to take medication along with the ECT treatments to keep the depression from returning.

Up to 80 percent of older adults who are treated with an antidepressant, psychotherapy, or a combination of both find relief from depression. Treating depression also helps improve the outcomes of any co-occurring illnesses.

Unfortunately, late-life depression often goes undiagnosed or is inadequately treated. Some studies have found that up to 75 percent of older adults who die by suicide had visited their doctors within one month of their deaths. However, researchers are working to help both doctors and patients better recognize the signs of depression and the potential for suicide in older adults.

One study is developing and testing an education and intervention program designed to help primary care clinics and providers identify and treat late-life depression. Another study found that depressed older adults who had a "care manager" monitor their symptoms, side effects, and progress got better more quickly -- and stayed better longer -- than those who did not have case-managed care.

Finally, researchers are studying the role of hormone changes in late life to find out if hormone replacement therapy may benefit older adults with depression. Other studies are looking to better understand the relationship between other medical illnesses and depression. Still others are looking to help older adults get better access to depression treatment.

If you are thinking about harming yourself or attempting suicide, tell someone who can help immediately. Call your doctor, call 911, or go to the nearest emergency room.

You can also call the National Suicide Prevention Lifeline, 24 hours a day, seven days a week, at 1-800-273-TALK (1-800-273-8255; TTY: 1-800-799-4TTY (4889) to speak to a trained counselor at a suicide crisis center nearest you.