At what age does depression generally occur?

Depression in old age

Most people have to cope with drastic and often negative changes and emotional stress in their old age. Work ends in this phase of life, the loss of a partner, family members and friends occurs and one's own health problems increase. It is not uncommon for there to be supply problems, loneliness and changes to the usual living situation. The loss of autonomy as well as the fear of death are factors that can lead to a feeling of helplessness and senselessness or even weariness with life.

Sub-syndromic depression common

Age-related neurodegenerative diseases such as Alzheimer's dementia and Parkinson's disease are often associated with symptoms of a depressive disorder. Further etiological factors are, on the one hand, the increasing cerebral blood circulation in old age and, on the other hand, the increasing lack of norepinephrine, serotonin and dopamine in the functional systems of the CNS responsible for mood regulation.

Against this background, it would be expected that depressive illnesses would occur particularly frequently in old age. However, the data of almost all epidemiological studies in recent years show the opposite: Depression that meets the criteria of the current international classification ICD-10 ("Major Depression") occurs less often in old age than in younger people. The problem here is that the form and symptoms of depressive disorders that manifest themselves in old age have not yet been adequately recorded or systematically described. In addition, atypical or mild to subliminal depression occurs more frequently in older people. Otherwise, the point in time at which the first signs of a depressive disorder show up is before the age of 32 in half of those affected.

Regardless of these uncertainties, the prevalence of the depressive syndrome in older people in Germany is estimated to be eight to ten percent, with information on "subsyndromal" depression reaching up to 30%. It is interesting that such a strong occurrence of this syndrome has not been reported from other European countries. Possibly this phenomenon in Germany is based on an accumulation of traumatization experiences of the war generation that is now aging. The prevalence of depressive episodes is estimated to be up to 50% and of major depression to be 15% to 20% in people living in care homes. Overall, after dementia, depressive syndromes represent the second largest group of mental disorders in old age.

High suicide rate in old age

As psychological autopsy studies show, mental illness is closely associated with the implementation of suicidal ideas. A mental illness can be detected in advance in 65 to 90% of completed suicides, with depression in up to 70% of the cases. Especially in old age, the suicide risk and the suicide rate are considerably higher, especially in men (Fig. 1). Characteristic here is an increased lethality of suicidal acts due to the more frequent choice of "hard" methods, such as hanging, shooting or jumping from a great height.