Why depression in old age is so common – and often diagnosed too late

After ten days in hospital, former Trigema CEO Wolfgang Grupp announced his suicide attempt in a moving letter to his employees. The " Bild " newspaper, which has the letter in its entirety, reports this. Dated July 17, Grupp wrote:

"I'm 84 years old and suffer from what's known as age-related depression. You start to wonder whether you're still needed. That's why I tried to end my life. It might take a while until I'm fully recovered."

"Depression is the most common mental illness in old age," explains neurologist Mimoun Azizi in his guest article for FOCUS online. It is "often associated with a high rate of suicidality." Azizi is chief physician of geriatrics/neurogeriatrics at Celle General Hospital and a specialist in psychiatry and psychotherapy.

Depression does not affect older people more frequently than younger adults. The German Depression Help Center writes : "According to a study on the health of adults in Germany by the Robert Koch Institute ( DEGS ), 8.1 percent of all people aged 18 to 79 develop depression over the course of a year. If we consider only those aged 70 to 79, the figure is 6.1 percent."

However, milder depressions or those in which not all symptoms are present are two to three times more common in older people.

A look at the official statistics on causes of death from the Federal Statistical Office shows that the suicide rate increases with age. Depression Help summarizes: "The risk of dying by suicide is therefore extremely high, especially for older people. Approximately 35 percent of all suicides are committed by people over 65. In contrast, their share of the population is only approximately 21 percent."

Depression in old age isn't always easy to recognize. In addition to the classic symptoms, "depression in old age" also has age-specific characteristics, as the Depression Helpline explains:

• In older people, health-related problems are often the main focus and—due to depression—are perceived as more severe and threatening than they actually are. For example:
• existing back pain or tinnitus in the context of depression is perceived as increasingly unbearable,
• The concentration and comprehension difficulties associated with depression are often linked to the fear of possibly suffering from Alzheimer's dementia.
• If the doctor doesn't ask about the psychological symptoms of depression, such as hopelessness, suicidal thoughts, feelings of guilt, etc., depression may be overlooked as the underlying illness. Without an appropriate diagnosis, the illness can only be treated inadequately.
• Those affected often focus their attention and concerns on existing physical complaints, including various types of pain or sleep and digestive problems. Furthermore, older patients often have difficulty accepting mental illnesses as a separate condition, like other (physical) illnesses.

Due to the variety of symptoms, depression in older people is often diagnosed too late. "A delayed diagnosis negatively impacts treatment options and can significantly impair the quality of life of those affected," warns Azizi.

"Despite the growing importance of geriatric medicine and the challenges it presents, this field remains inadequately addressed in Western medicine. There is therefore an urgent need for improved diagnosis and treatment of depression in old age to improve the well-being and quality of life of older people."

Trigema CEO Wolfgang Grupp wrote in a letter that he had tried to end his life. "It may take a while until I'm fully recovered." Do you know a similar story and would like to share how the person successfully fought their way back to life? Write to: [email protected] .

The triggers for depression in old age are varied. Be it the death of a partner, sleep disorders, or physical limitations, for example due to illness. However, depressive symptoms in old age are often mistakenly interpreted as an untreatable reaction to unavoidable life stresses, Azizi criticizes.

"However, it is crucial to correctly identify these symptoms, as they are treatable through medical and social interventions and generally have a favorable prognosis. Early detection and treatment can minimize the risk of depression in old age."

Those affected by depression in old age can receive help, particularly through psychotherapy and drug therapy.

Psychotherapy is often a behavioral therapy, which, according to the German Depression Help Center, is also effective in older people. However, very few people over 60 seek psychotherapeutic help—they account for just six percent of patients.

Drug treatment, on the other hand, usually involves an antidepressant. Careful selection by the doctor is important to avoid interactions with other medications.

Despite the potential challenges of antidepressant treatment, it is particularly important for older people, emphasizes the German Depression Help : "Depression is a life-threatening illness in old age, even more so than in younger people."

• Consult a doctor

Hopelessness is a part of depression. Many sufferers therefore believe that no one can help them. But that's not true! Support your loved one in going to the doctor if they haven't already. Remind them that depression is an illness and that they are not to blame. But also remind yourself of all these things: You are not to blame. And: You, too, can and should seek help if you are desperate.

• Don't take rejection personally

Especially during difficult times, those affected often withdraw, don't want to see anyone, don't want to do anything. This has nothing to do with you. Understand: This is the illness, not the person.

Regularly do things that are good for you and allow you to recharge. Maintain contacts. Treat yourself: a stroll through town, a trip to the movies. Don't feel selfish about it. Only those who have can give.

Don't tell yourself, "Love has to endure this." Be aware of your own limits. And express these to your partner: "I need some space now." "It's getting too much for me." "I'm not going to discuss this any further."

Are you suffering from suicidal thoughts? A contact point for anyone experiencing mental distress is the telephone counseling service, which can be reached nationwide at 08001110-111 or -222.

If you would like help and are looking for an outpatient therapy placement, you can call 116117. They will provide you with contact information and appointment times.

The online platform "Friends for Life" provides support for those facing impending suicide. The AGUS is a nationwide self-help organization for those grieving after the loss of a loved one to suicide. Further information is also available from the German Society for Suicide Prevention . A directory of counseling centers can be found here: Suizidprophylaxe.de .