Bob: You do not give a damn about yourself, anybody, or anything. You want to eat; but cannot. You want to sleep; but cannot. The pride you took in your clothes and home dissipates. Just like my "girl" of 60 years and my life-long friends. I just felt a terrible sadness and hopelessness. This is how 86 year old Robert P. describes depression.

Ms. Pency: The main thing is not to let yourself get depressed in old age. After I lost my husband and later, my son, I remained in the family home for too long. One day, I looked in the mirror and said "girl you need help". Therefore, I forced myself to get up and get dress. I said to myself, I must go out into the fold again with my people. This is how 82 year old Pency M. fights depression.

Stanley: On this, we could talk all year. All of us here are experts on how to survive old age. I can still write, thank the heavens! This clarifies my thinking and stops occasional periods of depression, anxiety and fears of senility. This is how 78 year old Stanley fights depression.

"How many of us older persons have really been…prepared for the second half of life, for old age, death and eternity?" Carl Jung, Modern Man in Search of a Soul, 1933.

For many years most of the problems of older people were lumped together under the heading of "senile disorders." We now know that several different types of psychological and behavioral problems occur among old people. The elderly are vulnerable both to serious consequences of brain changes such as senile dementia and to certain other psychological conditions such as those in which the role of organic factors is much less clear-cut.

More than two million of the 34 million Americans age 65 and older suffer from some for of depression, according to the National Institute of Mental Health (NIMH). However, statistics from the NIMH also show that 50 percent of the time, physicians miss or misdiagnose depression in older adults.

A large reason older people become depressed are the loss and grieving they experience. They lose their spouses of 60 years, their children may die before they do, or their grandchildren may predecease them. Generally, the aging person must whether tremendous loss. For example, depressive episodes increase in both frequency and depth in the later years of life (Hamilton, 1989). Depression is likely to be provoked by the beginning of an illness or disability or the death of a spouse, but given time, most people adjust to these changes.

The majority of severe depressions in old age are relapses, although new cases may occur even after the age of 75. Recognizing and treating depression in older adults is complicated according to Marion Becker, Ph.D., and Associate Professor in the Department of Mental Health at the Florida Mental Health Institute of the University of South Florida.

Older people are more likely to suffer more than one illness at a time, requiring multiple diagnoses and medications, says Dr. Becker. Symptoms from diseases like dementia, delirium, Parkinson's disease, or stroke, may overlap, mimic, or distort symptoms of depression, according to the American Association for Geriatric Psychiatry. These disorders make it easy to overlook treating depression in the elderly. Studies support also that generally doctors spend less time with patients the older they get, Becker adds.

Depression occurs at higher than average rates in heart attack and cancer patients, persons with diabetes, and post-stroke patients, according to NIMH. These are all diseases that are more prevalent in the elderly. "Chronic illness, which often afflict the elderly, go hand in hand with depression," Dr. Becker states. Furthermore, common medications used to treat illnesses found in the elderly can cause depression. Those with a higher incidence of hypertension (high blood pressure) may suffer from depression because of the medication.

Moreover, another factor that plays into the increased rate of depression the elderly is a reluctance to tell a provider about psychological symptoms, according to the Surgeon General's Report on Mental Health. Usually, older people do not come forth as quickly as the younger ones do. Living in a society that does not encourage anyone, regardless of age, to talk about mental illness makes things more complicated.

Realistically, to live is to grow older. The down side of growing older is, i.e.: income shrinks, work is taken away, the body deteriorates, recall fades, energy wanes, family members and friends die, or move away, and the great enemy, death, looms ever closer. Conversely, the up side is viewed generally by our aging population that growing older is the consequence of living, an outcome most seem to prefer, to its alternative.

Consequently, the public needs to learn more about mental illness, as well as how it can affect older adults. We need to start talking about depression in all ages. And, if you observe that feeling down is getting to be a habit with an elderly person in your life, or that the individual is just not bouncing back, then you may want to encourage an appointment for an assessment and evaluation be made with a mental health professional.

To learn more about adulthood and aging issues, contact the Administration on Aging (202-619-7501) or the National Institute of Mental Health (301-443-4513). Both agencies provide information on identifying and treating depression in the elderly or feel free to call the Program Administrator, Carol P. Waldhauser, at the MSBA'S Lawyer Assistance Program (410) 685-7878 Ex. 253 or e-mail cwaldhauser@msba.org to get additional information and resources for mailing and Internet addresses.