Finding the appropriate treatment for depression often takes time and trial.  Proper treatment can result in dramatic improvement in mental and physical health, so it is important to take the time necessary to find the treatment that works best for you.

Depression is a very real and serious medical illness.  It, therefore, requires medical attention and treatment. 

If you have several of these symptoms and they last for more than two weeks, talk to your doctor.¹

• An "empty" feeling and ongoing sadness
• Persistent anxiety
• Tiredness, lack of energy
• Loss of interest or pleasure in everyday activities, including sex
• Sleep problems, including trouble getting to sleep, very early morning waking, and sleeping too much
• Eating more or less than usual
• Crying too often or too much
• Aches and pains that do not go away when treated
• A hard time focusing, remembering, or making decisions
• Feeling guilty, helpless, worthless, or hopeless
• Being irritable
• Being restless or agitated
• Thoughts of death or suicide

Seeking treatment is your first step to recovery.

The main treatments for depression are psychotherapy and medication. For some people, either treatment alone may work. For others, a combination of the two may be needed.  When these first-line treatments do not work or you can not take the medications because of adverse side effects or co-existing medical conditions, neurotherapeutic treatments may provide relief.   These treatments include electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS). 

Psychotherapies
These are referred to as the "talking" therapies and they come in many forms.  Popular types for treating late onset depression include cognitive-behavioral therapy, supportive psychotherapy, problem-solving therapy, and interpersonal therapy.² Cognitive-behavioral therapy helps you identify and change pessimistic thoughts and beliefs that can lead to depression. Supportive, problem-solving and interpersonal therapies are geared toward helping you develop new ways to cope with problems. 

Medication
Antidepressants are used most often for serious depressions, but they can also be helpful for some milder depressions. Antidepressants are not "uppers" or stimulants, but rather take away or reduce the symptoms of depression and help depressed people feel the way they did before they became depressed.³   There are several different types of antidepressants, each working in different ways with different applications.  Finding the right medication and the right dosage can be a long process. Older adults tend to be more sensitive to drug side effects and because they are often taking other medications, they can be more vulnerable to drug interactions.  They are also likely to have a slower response than younger patients (8 to 12 weeks which is double the time it may take a younger person to experience a change according to the Cleveland Clinic).  If the first or even second medication does not work, you should not give up.  You may need to try several different medicines, take more than one medicine or add other forms of treatment for optimal effect.  When antidepressants are prescribed by a physician who is familiar with those that are best for geriatric patients, they can work just as well for older adults as they do for their younger counterparts.    

Electroconvulsive Therapy (ECT)
Statistically ECT is the most effective treatment for depression.  In fact, older patients seem to respond better than younger ones.  Patients who have opted for ECT commonly report high satisfaction after initial doubts.  Many say the impact of the procedure is "nothing" compared to the illness it overcomes.  Some 80-90 percent of people with severe depression improve dramatically with ECT.  It involves producing a seizure in the brain of a patient under general anesthesia by applying electrical stimulation to the brain through electrodes placed on the scalp.  Repeated treatments are necessary to achieve the most complete anti-depressant response.  Memory loss and other cognitive problems are common yet typically short-lived side effects of ECT.  While some people report lasting difficulties, modern advances in ECT technique have greatly reduced the side effects of this treatment compared to those of earlier decades.

Vagus Nerve Stimulation (VNS)
VNS approved by the FDA in July 2005 as an additional treatment for long-term or recurrent depression in adults who have not had success with four or more antidepressant medicines. A device is put into the chest and sends an electrical current to mood centers of the brain.  There is controversy among physicians about how the studies on VNS were conducted and whether this is, in fact, an effective therapy. 

Transcranial Magnetic Stimulation (TMS)
A TMS device, NeuroStar, manufactured by Neuronetics Inc. was approved on October 8, 2008, by the FDA for use in adult patients with major depression who have previously tried medication and not improved satisfactorily.  It is not yet widely available and many physicians still consider this to still be an experimental therapy.  According to Neuronetics, the therapy stimulates nerve cells in an area of the brain that is linked to depression by delivering highly focused MRI-strength magnetic pulses. A large electromagnetic coil is held against your scalp near your forehead to produce the pulses.  Patients do not require anesthesia or sedation and remain awake and alert for the 40-minute outpatient procedure.

Deep Brain Stimulation (DBS)
This therapy was first developed and approved for treatment of Parkinson's disease and essential tremor.  It is under study for the treatment of severe depression so is still considered to be experimental.   

There are also lifestyle changes that individuals with depression can make.  They include increased exercise, an improved diet, regulating sleep and reducing or eliminating caffeine and alcohol.

Of utmost importance is to remember that depression is not a static thing.  Since it can fluctuate in severity and range, it requires regular monitoring and therapeutic adjustments.

¹ National Institute on Aging.
² Alexopoulos GS, Katz IR, Reynolds CF III, Carpenter D, and Docherty JP. The Expert Consensus Guideline Series: Pharmacotherapy of Depressive Disorders in Older Patients. Postgraduate Medicine Special Report. October 2001.
³ Medications.  National Institute of Mental Health. 

Learn more about Depression in Later Life:

Key Point 1: When a person is not thinking clearly, it can be caused by many different issues.  Depression is one of them.