The elderly have a high rate of depression but may not exhibit the usual signs. They may stop eating, become withdrawn, have irregular sleep patterns or exhibit signs that resemble dementia.
The usual patient admitted to the hospital is the 'overdose' who is looking for help from us, the medical profession. In my experience, doctors are somewhat dismissive of the depressed patient and don't want to ask too many details about the underlying cause for their depression.
I have seen with my own eyes how depression can have fatal consequences.
A friend of mine was also affected by depression and to see her consider suicide and watch her mental state and body weight decline was a wake up call that depression should never be considered trivial or just a mere problem that we send to the psychiatrists.
Depression can be mild and that is something we have all experienced at some time or other. However, severe depression can be cause severe morbidity or can even be fatal if the patient takes their own life.
As doctors we must take depression seriously and when taking a history ask the patient if they feel depressed. A simple question ! However, asking about other symptoms such as appetite loss, weight loss, impaired sleep, impaired concentration, suicidal ideation etc should be other such questions to move on to if you suspect depression.
Remember, that some symptoms have no identifiable physical cause and they can be due to somatisation which can be associated with depression.
Depression should not be left untreated especially in the elderly. Treatments such as the SSRIs, SNRIs are very effective albeit that they take several weeks to show an effect.
If sleep is a problem then the older drugs such as the Tricyclic antidepressants can be of benefit but remember that there are frequent side effects especially anti-cholinergic and they can cause daytime drowsiness in the elderly and precipitate falls.
SSRIs and Tricyclics should not be prescribed together and there should be at least a two week 'wash out' period before starting a new anti-depressant.
In the UK, severe depression unresponsive to drug therapy is sometimes treated with ECT (Electroconvulsive therapy) which is said to have good effect.
Remember that in your elderly patient with the label of 'dementia' it may be depression and there is little harm in providing a trial of SSRI / SNRI therapy once organic causes of dementia have been ruled out and that depression remains the most likely diagnosis.