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Contrary to popular opinion, getting older doesn’t mean that depression, which can cause persistent sadness, is inevitable.

“There’s sometimes a myth that aging is somehow depressing,” says Emily Haigh, Ph.D., an assistant professor in the department of psychology at the University of Maine.

In fact, only about 2 to 5 percent of older people may have major depression, which is marked by at least five significant symptoms (see below)—though up to 16 percent may experience some symptoms.

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But in older adults, it can be more difficult to determine whether true depression or something else is the cause. Some heart medications, for instance, can cause depression-like side effects, says Steve Koh, M.D., M.P.H., M.B.A., a geriatric psychiatrist and an associate clinical professor at the University of California, San Diego.

No matter the cause, getting treatment is key. People with depression are at higher risk for other health problems, as well as suicide.

How the Symptoms Differ

The major signs tend to be the same at any age: feeling sad, hopeless, guilty, or worthless; a loss of interest in activities you once enjoyed; changes in appetite, weight, or sleep habits; fatigue, restlessness, indecisiveness, or difficulty concentrating; and suicidal thoughts.

These signs may look different in seniors. “Older adults may not really complain of sadness,” says Mijung Park, R.N., M.P.H., Ph.D., an assistant professor in the school of nursing at the University of California, San Francisco. “But they may say, ‘I don’t feel joy.’ That’s a very different symptom presentation than a younger person.”

If you experience any of the above, tell your doctor. More than 80 percent of seniors with depression get treatment from a primary care provider. Some docs will even work with a nurse or social worker dedicated to helping you manage your care.

Easing the Sadness

What might your doctor do? Here, a rundown of possible treatments.

Talk therapy. Trying therapy first can be a good option for older adults who may already take multiple medications. One common type is cognitive behavioral therapy, which teaches you to change unhelpful patterns of thinking and behaving.

Antidepressants. You may be a good candidate for antidepressant medication if you’ve tried therapy and haven’t started to feel better after a few months, or if your symptoms are severe—for instance, you’re eating so little that you’re losing weight, you’re not sleeping, or you’re even having delusions or hallucinations.

Your doctor may recommend therapy and medication together. “The combination treatment is oftentimes superior” to one or the other on its own, Koh says. (It can take eight to 12 weeks for antidepressants to take full effect.)

Electroconvulsive therapy (ECT). If you’ve tried therapy and several different drugs but your depression still isn’t improving sufficiently, your doctor may recommend ECT, which involves using a small electric current to stimulate the brain while you are under anesthesia. A 2015 study in the American Journal of Geriatric Psychiatry found that ECT led to an easing of symptoms for up to 80 percent of people.

And there’s no reason to fear the therapy. “What people see in movies—it’s not like that at all,” Koh assures.

Can Exercise Help?

Research suggests that physical activity can offer mood-lifting benefits even for major depression. An analysis of 25 studies, published in the Journal of Psychiatric Research in 2016, found that regular exercisers were more likely to see symptoms improve compared with people who did no exercise.

Strive for regular aerobic and strengthening exercise. Depression can sap your motivation, so enlisting a buddy can help get you up and out. Or sign up for a class. Social interaction can help you feel better, too, according to Park.

And aim to eat right. A study published in 2018 in Experimental Gerontology found that following a Mediterranean diet, which emphasizes fruits, vegetables, legumes, and healthy fats, was linked to a lower risk of depression.

Editor’s Note: This article also appeared in the March 2019 issue of Consumer Reports On Health.