Depression is not a normal part of getting older.² When low mood, tiredness or loss of interest last for weeks, it is worth checking. Effective treatment is available, and a primary care doctor is a good place to start.¹

In later life, depression is easy to miss. It may show up as aches, poor sleep or memory trouble rather than sadness.

Key points

Depression in later life is common, but it is not "just aging." It can be treated, often in your regular doctor's office.
It often looks like tiredness, pain, poor sleep, irritability or memory problems instead of sadness.
Depression and dementia can look alike, and they can happen together. A full checkup helps sort this out.
Medicare Part B covers a yearly depression screening, usually at no cost to you, and therapy with many kinds of licensed counselors.
Men 75 and older have the highest suicide rate of any age group. If you are worried, call or text 988. In an emergency, call 911.

How depression can look different later in life

The core signs of depression are the same at any age (see Signs and symptoms of depression). But in older adults the picture often shifts. Tiredness, low appetite and poor sleep are easy to blame on age or on another illness, so early depression may be overlooked.² Other signs to watch for include:¹

Ongoing headaches, stomach trouble or pain with no clear cause
Feeling flat, or not enjoying things that used to bring joy
Irritability, anger or restlessness
Trouble concentrating
Pulling back from family, friends, church or other activities
Thoughts or talk of death or suicide

Many older people never say "depressed." They may say they feel worn out or "not myself." If that lasts more than two weeks, tell a doctor.

What raises the risk later in life

Illness and pain. Heart disease, stroke, cancer, Parkinson's disease, thyroid problems and dementia are all linked to depression.² Long-term pain is a risk too.² See Depression with heart disease, stroke, diabetes and pain.

Loss and change. The death of a spouse or close friend, moving out of a longtime home, children moving away and giving up driving can all raise the risk.²

Isolation and loneliness. Older adults are more likely to be socially isolated. Isolation and loneliness raise the risk of depression, and depression can make people pull away even more.³ See Loneliness in later life.

Medicines and alcohol. Some sleep aids and heavy drinking can make depression worse.² See Medicines that can affect mood and memory and Alcohol in later life.

What is vascular depression?

"Vascular" means having to do with blood vessels. Researchers have long proposed that some depression that starts late in life is linked to damage in the brain's small blood vessels.⁴

On brain MRI scans, this damage often shows up as bright spots in the white matter. White matter is the brain's wiring, the pathways that connect different areas. These bright spots are linked to blood vessel risk factors, the same kinds of things that raise the risk of heart disease and stroke.⁴

People with this kind of depression often have trouble with planning, organizing and switching between tasks. Doctors call these skills "executive function." Problems with these skills have been linked to a weaker response to antidepressants.⁴ Treatment can still help, but your care team may need to try more than one approach.

Is it depression or dementia?

Depression and dementia share many signs. Both can cause loss of interest, pulling away from people, poor focus and trouble thinking.⁵ Severe depression can look so much like dementia that families are not sure which it is.²

They can also happen together. Experts estimate that up to 40 percent of people with Alzheimer's disease, about 2 in 5, have significant depression. It is most common in the early and middle stages.⁵

Depression that comes with Alzheimer's can look different from other depression:⁵

It may be milder, and the low mood may come and go.
It may show up with physical complaints, such as pain or tiredness.
In later stages, the person may not be able to put sadness or guilt into words.

There is no single test that tells the two apart. A good checkup includes a health history, physical and mental exams and talks with family members who know the person well.⁵ Your doctor may also order blood and urine tests to look for other illnesses.² A geriatric psychiatrist (a doctor who treats mental health in older adults) can help in hard cases. See Apathy and depression in dementia.

Is it grief or depression?

Grief after a loss is normal and can hurt a great deal. It shares some signs with depression, but there are key differences.⁶

Grief often looks like this

Painful feelings come and go in waves
A sense of emptiness or longing for the person
Self-worth stays mostly intact
Thoughts of death are about joining the person who died

Depression often looks like this

Low mood stays most of the time
Sadness and loss of pleasure in almost everything
Feelings of worthlessness
Thoughts of death are about yourself and your own life

For most people, the hardest grief symptoms ease somewhere between six months and two years after the loss.⁶ Depression can also start during grief, and it can be treated. After losing a spouse, men tend to have worse depression than women. One reason may be that men often have less support after a loss.⁶ See Grief, Losing a husband or wife and Prolonged grief disorder.

Treatment that works in later life

Both talk therapy and medicine help depression in older adults. The benefits are moderate. Medicine studies in older adults show smaller effects.⁷ See Treatment for depression.

Talk therapy

Strong evidence

Talk therapy, such as CBT (cognitive behavioral therapy, which works on unhelpful thoughts and habits), helps older adults.⁷ Problem-solving therapy was one of the options in a large trial of older adults.⁸ Therapy can be done in person or by video from home.¹²

Antidepressant medicine

Moderate evidence

Helps many people. In older adults the benefit is moderate, and harms are usually no more than moderate. Older adults need extra care with side effects (see below).⁷

Team-based care in your doctor's office

Strong evidence

In "collaborative care," a care manager and a psychiatrist work with your regular doctor and track your progress. In one large trial of about 1,800 people 60 and older, nearly half had their symptoms drop by at least half within a year. With usual care, only about 1 in 5 did.⁸

Staying active and connected

Moderate evidence

Regular movement (if your doctor says it is safe), good sleep habits and time with people support recovery.² See Self-help for depression and Ways to feel more connected.

If depression does not improve, other options include changing or adding medicines and brain stimulation treatments. See When depression doesn't get better.

Using antidepressant medicine safely

Older bodies often handle medicines differently. Doctors usually start older adults on a lower dose and raise it more slowly. The usual phrase is "start low and go slow."^2,9 Most antidepressants take several weeks to work fully.

Some risks matter more after 65. The FDA label for sertraline (Zoloft) lists these warnings for its drug group:⁹

Low sodium in the blood. SSRI and SNRI antidepressants can lower sodium. Older adults and people taking water pills (diuretics) are at higher risk. Signs include headache, confusion, memory trouble, weakness and unsteadiness, which can lead to falls.
Bleeding. The risk of bleeding rises when these medicines are taken with aspirin, pain relievers like ibuprofen or naproxen, or blood thinners such as warfarin.
Serotonin syndrome. This serious reaction can happen when several medicines that raise serotonin are combined. Signs include agitation, fast heartbeat, fever, shaking and diarrhea. Get medical help right away.

The American Geriatrics Society keeps a list called the Beers Criteria. It names medicines that are often riskier for people 65 and older. Examples include older antidepressants such as amitriptyline, sleeping pills such as zolpidem (Ambien), anxiety medicines such as lorazepam (Ativan) and the allergy medicine diphenhydramine (Benadryl).¹⁰ Being on the list does not mean you must stop a medicine. Ask your doctor or pharmacist to check your medicines against it.

Bring all your medicines Once a year, bring all your pills, vitamins, herbal products and over-the-counter medicines to your doctor or pharmacist for a "brown-bag review."

Do not stop an antidepressant suddenly or change the dose on your own. Talk with your doctor or pharmacist before changing anything. Also limit alcohol, which can worsen depression and interact with many medicines.²

For more detail, see Antidepressant medicines.

What Medicare covers for depression

As of October 2026, Original Medicare covers the services below. Medicare Advantage plans cover them too, but costs and rules may differ.

Service	What Medicare covers
Yearly depression screening	One per year in a primary care office that can provide follow-up. You pay nothing if your provider accepts Medicare's approved amount.¹¹
Therapy and medicine visits (Part B)	Individual and group therapy, family counseling when its main goal is your treatment, psychiatric evaluation and medicine checks. You pay 20 percent of the approved amount after the Part B deductible. Hospital outpatient clinics may charge an extra copay.¹¹
Who can treat you	Psychiatrists and other doctors, clinical psychologists, clinical social workers, nurse practitioners, physician assistants, clinical nurse specialists, marriage and family therapists and mental health counselors.¹¹
Telehealth	Therapy and depression screening by video from anywhere in the U.S., including your home, through December 31, 2027.¹²
Suicide safety planning	Help making a safety plan if you are at risk of suicide or overdose, and a follow-up call after an emergency room visit for a mental health crisis.¹¹
Medicines (Part D)	Drug plans must cover most antidepressants. Costs depend on your plan. "Extra Help" can lower costs if your income and savings are limited.¹³
Hospital care (Part A)	Inpatient mental health care. Stays in a separate psychiatric hospital have a 190-day lifetime limit.¹³

The one-time Welcome to Medicare visit reviews your risk for depression. The yearly Wellness Visit looks at changes in your mental health.¹¹ For more, see What Medicare covers for mental health and Paying for therapy.

Suicide risk in older men

In the United States, men 75 and older have the highest suicide rate of any age group. In 2024, their rate was about 40 per 100,000, or about 4 in every 10,000 men that age. That is nearly 9 times the rate for women the same age.¹⁴ Divorced or widowed men, especially those who live alone, are at particular risk.²

Warning signs include:¹⁵

Talking about wanting to die, or feeling like a burden to others
Feeling hopeless, trapped or in unbearable pain, emotional or physical
Pulling away from people, saying goodbye, giving away important things or making a will
Drinking more, or big changes in sleep or eating

Ways to help:

Ask plainly and calmly, "Are you thinking about ending your life?" Listen without arguing. See Helping someone with depression.
Make the home safer. Lock up firearms and medicines, for example in a gun safe or lock box, or have someone else keep them for a while. Putting them out of sight is not enough.¹⁶ See Guns in the home.
Help the person stay connected. Feeling connected to others protects against suicide.¹⁶
Make a safety plan together. Medicare covers safety planning.¹¹ See our safety plan tool.

Depression in older men is treatable at any age. Reaching out early can save a life.

If someone is in danger Call or text 988 (Suicide & Crisis Lifeline) any time, day or night. If someone is in immediate danger or has hurt themselves, call 911 and do not leave them alone. See When a family member is in a mental health crisis.

When to get help

See a doctor if you or someone you love:

Has felt down, empty or uninterested in most things for more than two weeks
Has new memory or thinking problems, or a big change in sleep, appetite or energy
Is withdrawing from people or activities they used to enjoy
Is grieving and still unable to manage daily life after many months
Is drinking more or using more sleep or pain medicine than before

Ask for the yearly depression screening at your next primary care visit, or take our private check-in first and bring the results. Call or text 988 for thoughts of suicide, and call 911 in an emergency. See also Get help, Finding geriatric mental health care and our older adults section.

In crisis or thinking about suicide? Call or text 988 (Suicide & Crisis Lifeline, 24/7, free). If someone is in immediate danger, call 911.

Sources

National Institute of Mental Health. Older adults and mental health. NIMH, 2024. NIMH
MedlinePlus. Depression - older adults. U.S. National Library of Medicine, 2024. MedlinePlus
Centers for Disease Control and Prevention. Risk factors for social isolation and loneliness. CDC, 2024. CDC
Taylor WD, Aizenstein HJ, Alexopoulos GS. The vascular depression hypothesis: mechanisms linking vascular disease with depression. Mol Psychiatry, 2013. Molecular Psychiatry
Alzheimer's Association. Depression. Alzheimer's Association. alz.org
National Cancer Institute. Grief, bereavement, and coping with loss (PDQ), patient version. NCI, 2025. NCI
U.S. Preventive Services Task Force. Depression and suicide risk in adults: screening. USPSTF, 2023. USPSTF
Unützer J, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA, 2002. JAMA
U.S. Food and Drug Administration. Zoloft (sertraline) prescribing information. DailyMed, 2023. DailyMed
AGS Health in Aging Foundation. Alternatives to medications listed in the AGS Beers Criteria for potentially inappropriate medication use in older adults. American Geriatrics Society, 2023. HealthinAging.org PDF
Medicare.gov. Mental health care (outpatient). Centers for Medicare & Medicaid Services, 2026. Medicare.gov
Medicare.gov. Telehealth. Centers for Medicare & Medicaid Services, 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Medicare and your mental health benefits: getting started. CMS, 2026. Medicare.gov PDF
Garnett MF, Zehner AM. Changes in suicide rates in the United States from 2023 to 2024. NCHS Data Brief No. 572, 2026. CDC
National Institute of Mental Health. Warning signs of suicide. NIMH. NIMH
Centers for Disease Control and Prevention. Suicide prevention strategies. CDC, 2026. CDC

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.