Geriatric depression is major depressive disorder, persistent depressive disorder, or clinically significant depressive symptoms occurring in adults aged 60 and older, and it presents differently from depression earlier in life. Roughly 7% of community-dwelling older adults meet criteria for major depression and another 10-15% have clinically meaningful subsyndromal symptoms; rates rise to 14-42% in nursing-home residents and 30% in older adults hospitalized for medical illness.
Geriatric depression (often coded as F33.x or F32.x in ICD-10; F03.91 with mood disturbance in dementia) is depressive illness occurring in adults aged 60 and older. DSM-5-TR criteria are the same as in younger adults — five or more symptoms during the same two-week period including either depressed mood or anhedonia, plus changes in sleep, appetite, energy, concentration, psychomotor activity, feelings of worthlessness or guilt, and thoughts of death — but the phenotype differs. Older adults more often endorse loss of interest, fatigue, sleep disturbance, multiple unexplained somatic complaints, irritability, and concentration problems than overt sadness, leading to the classic 'depression without sadness' presentation. Cognitive slowing can mimic dementia (the 'pseudodementia' picture), and depression and dementia coexist in 20-30% of older patients with either diagnosis.
The key symptoms of Geriatric Depression are: Persistent low mood, irritability, or 'numbness' lasting at least two weeks; older adults often describe feeling 'empty' or 'flat' rather than sad., Loss of interest or pleasure in activities previously enjoyed (anhedonia), often presenting as withdrawal from family meals, religious practice, hobbies, or grandchildren., Fatigue and lack of energy out of proportion to medical illness, with daytime sleepiness despite sufficient time in bed., Sleep disturbance — early-morning awakening with inability to return to sleep, fragmented sleep, or hypersomnia — present in 60-90% of cases., Reduced appetite with weight loss of 5% or more over a few months, or, less commonly, comfort-eating with weight gain., Multiple somatic complaints without clear medical explanation: vague pain, headaches, gastrointestinal symptoms, dizziness, palpitations., Concentration problems and slowed thinking that can mimic early dementia (the 'pseudodementia' picture) but reverse with treatment..
Diagnosis combines a structured clinical interview, a validated rating instrument, and a focused medical and medication review to exclude reversible causes. The Geriatric Depression Scale (GDS-15 or GDS-30, dichotomous yes/no items) is the best-validated screen for cognitively intact older adults; the Patient Health Questionnaire (PHQ-9) is also widely used and is sensitive to change. For older adults with dementia, the Cornell Scale for Depression in Dementia uses caregiver and clinician observations to score 19 items and is the recommended instrument. DSM-5-TR criteria apply but the phenotype differs: clinicians ask explicitly about loss of interest, fatigue, sleep disturbance, somatic complaints, hopelessness, and passive death wishes rather than only sadness. Every assessment includes an explicit suicide-risk inquiry using the Columbia Suicide Severity Rating Scale. Medical workup screens for hypothyroidism (TSH), vitamin B12 and folate deficiency, vitamin D deficiency, anemia, hyponatremia, hypercalcemia, renal and hepatic dysfunction, and undiagnosed malignancy. Medication review identifies depressogenic drugs (beta-blockers, corticosteroids, opioids, interferons). Cognitive testing with the Montreal Cognitive Assessment distinguishes depression-related cognitive slowing from dementia. Brain imaging (MRI) is reserved for atypical presentations, focal neurological signs, or treatment resistance, when it may reveal vascular depression. Severity, suicide risk, functional impairment, and psychosocial supports together guide stepped care from primary-care management to specialist psychiatric and inpatient treatment.
Outlook depends on severity, comorbidity, and treatment access. With adequate dose and duration of pharmacotherapy plus evidence-based psychotherapy, response (≥50% symptom reduction) occurs in 50-65% and remission in 30-40% of older adults at 12 weeks. ECT produces response in 70-90% in treatment-resistant or severe depression. Without treatment, late-life depression is associated with doubled non-suicide mortality (cardiovascular disease, stroke, cancer), worse recovery from medical illness, higher rates of nursing-home placement, and substantial suicide risk — men aged 75 and older have the highest suicide rate of any US demographic. Untreated or under-treated late-onset depression also increases the risk of subsequent dementia by 50-80% over 5-10 years, an effect that is partially modifiable by treatment. Maintenance therapy at the effective dose for at least 12 months after a first episode and indefinitely after two or more episodes reduces recurrence by 50-70%. Long-term outcomes are better in those with adequate social support, exercise, and well-controlled vascular risk factors.
Geriatric psychiatry referral is recommended for psychotic depression, active suicidal ideation, catatonia, treatment resistance after two adequate antidepressant trials, complex polypharmacy, coexisting dementia with behavioral disturbance, and consideration of ECT or TMS. Specialist input improves remission rates and reduces hospitalization and suicide risk.
Find specialists →Initial improvement (sleep, appetite, energy) often within 2-4 weeks of starting medication; mood and anhedonia improve over 4-8 weeks. Full response typically at 8-12 weeks. Psychotherapy gains over 6-12 sessions. ECT response in 2-4 weeks. Maintenance therapy for at least 12 months after a single episode, longer with recurrence.
Most older adults with depression benefit from 150 minutes per week of moderate aerobic activity (brisk walking, stationary cycling, swimming) plus twice-weekly resistance and balance training. Group-based exercise programs add social benefit. Start at 10-15 minute increments if deconditioned and progress over weeks. Coordinate with physical therapy for those with falls, frailty, or recent fracture.
Look for a board-certified geriatric psychiatrist or a psychiatrist with explicit experience in late-life mood disorders. For ECT, choose a center with a dedicated ECT service and anesthesia familiar with older adults. Confirm availability of a clinical psychologist trained in evidence-based geriatric psychotherapy for combined care.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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