Understanding and Addressing Common Misconceptions of Depression in Later Life

Author: Veronica du Plessis

Our recent discussion centered around an article titled “Depression Among Older Adults: A 20-Year Update on Five Common Myths and Misconception”. This article revisited a 1997 study that challenged five myths about depression in older adults, highlighting new insights on the subject. The findings of this article hold the potential to positively impact the mental health community as they challenge outdated assumptions that may have led to misdiagnosis, undertreatment, or ineffective interventions for older adults. If depression is better recognized and treated in this population, it could lead to improved quality of life, increased independence, and even longer life expectancy. On a broader scale, changing the conversation about mental health in aging populations can reduce stigma, ensuring that older individuals feel empowered to seek and receive the mental health care they need.   
The article listed the first myth that depression is more common in older adults than in younger individuals. Earlier studies suggested that aging led to increased sadness and depressive symptoms. However, more recent research, such as Blazer (2003), has demonstrated that the prevalence of Major Depressive Disorder (MDD) is actually lower in older adults compared to middle-aged individuals. This shift in understanding is partly due to improved diagnostic tools and a better distinction between normal aging and clinical depression (Cole & Dendukuri, 2003). Another evolving perspective involves the causes of depression in older adults. Historically, psychological factors like grief and loneliness were considered the primary triggers. While these factors remain relevant, more recent studies emphasize biological and social determinants, including chronic illness, neurobiological changes, and social isolation, as key contributors (Fiske, Wetherell, & Gatz, 2009). This change in understanding has led to more comprehensive treatment approaches that incorporate medical, psychological, and social factors. 
Similarly, earlier beliefs suggested that depression manifests differently in older adults, primarily through physical symptoms rather than emotional distress. While some studies, such as Gallo et al. (1994), found a slight increase in bodily symptom complaints among older individuals, more recent research has shown that the overall symptom profile of depression remains consistent across age groups. This understanding has led to improved screening methods that ensure older adults receive appropriate diagnoses rather than attributing their symptoms solely to physical health conditions. The notion that depression in older adults is more chronic and treatment-resistant has also been reevaluated. While it is true that relapse rates are higher due to medical comorbidities and cognitive decline (Mitchell & Subramaniam, 2005), newer findings suggest that psychotherapy, particularly cognitive-behavioral therapy (CBT), is just as effective in older populations as in younger ones (Areán & Cook, 2002). Furthermore, while some earlier research indicated that antidepressant medications might be less effective in older adults, recent studies have focused on optimizing dosages and combining treatments for better outcomes (Nelson et al., 2008). 
The major findings of the article encompassed that Major Depressive Disorder in older adults is a complex issue influenced by many factors. The treatment, severity, and outcomes of depression depends on more variables such as health conditions than strictly age. The content of the article sparked exciting discussion, in which multiple implications of the article were brought to light. The increased awareness that depression in older adults is often linked to chronic health conditions and social isolation could place additional strain on healthcare systems. If depression is seen as part of a broader network of medical and social issues, treatment must extend beyond prescribing medication and include comprehensive care models- requiring more resources and coordination. Additionally, the research indicating that depression in older adults is more likely to relapse (Mitchell & Subramaniam, 2005) suggests that long-term treatment and follow-up care are crucial, potentially requiring sustained investment in geriatric mental health services. 
Furthermore, we discussed the social implications of such misconceptions, in particular stigma around mental health in aging. By challenging the myth that depression is a normal part of growing older, older adults may feel more encouraged to seek treatment. As a final note, we analyzed what factors could contribute to the establishment and continuation of misconceptions about mental health in the older age population, such as ageism, previous gaps in research, and the current focus on depression in younger age groups.  
Haigh, E. A. P., Bogucki, O. E., Sigmon, S. T., & Blazer, D. G. (2018). Depression Among Older Adults: A 20-Year Update on Five Common Myths and Misconceptions. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 26(1), 107–122. https://doi.org/10.1016/j.jagp.2017.06.011   ​