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Subsyndromal Depression in the Elderly

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An estimated 7 million Americans over the age of 65 experience subsyndromal depression, often undiagnosed and untreated, compared to 1.75 million senior citizens with major depression. (1)

Subsyndromal depression, which is especially common among the elderly, presents with symptoms that do not meet the criteria for major depression. Consequently, many elderly individuals are suffering and are at increased risk for developing major depression.

For the first time in history, we are approaching a time when older adults will outnumber children. A third of this population is expected to struggle with a mental disorder at some point.

Major depression is one of the conditions most commonly associated with suicide in older adults. (2) It overshadows related disorders with less serious symptoms leaving many elderly individuals more functionally disabled and less able to be live independently.

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, defines a minor depressive disorder as featuring one or more depressive symptoms that are identical to major depressive episodes in duration, but which involves fewer symptoms and less impairment.

An episode involves either a sad or “depressed” mood or loss of interest or pleasure in nearly all activities. To meet the criteria for diagnosis, at least two but less than five additional symptoms must be present.

Additional symptoms include changes in appetite or weight, sleep and psychomotor activity, decreased energy, feelings of worthlessness or guilt, difficulty thinking, concentrating or making decisions or recurrent thoughts of death or suicidal ideation, plans or attempts. (3 and 4)

The symptoms are either newly present or must be clearly worsened compared with the person’s pre-episode status. During a minor depressive episode, the symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. In some individuals, there may be near normal functioning but this is accomplished with significantly increased effort.

Many people misconceive depression as a normal part of the aging process. It is not.

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