Depression is a mental illness requiring treatment—at any age. It manifests through persistent dejection, a lack of joy, a lack of drive, and physical complaints that significantly restrict daily life.

These signs are therefore not simply "normal aging." Five changes in old age can foster depression:

1. Fewer social contacts because the professional environment is gone or friends withdraw, become ill, or die.
2. Physical limitations due to aging, lack of exercise, or illness.
3. Pain as a result of illnesses.
4. Hearing or vision loss.
5. The feeling of "being a burden."

However, if sadness, lack of drive, or hopelessness persist for weeks, sleep is disturbed, and managing daily life is barely successful, this is a warning sign.

Older people less frequently speak about "sadness." Many were raised to remain quiet and show strength. They are therefore more likely to report fatigue, sleep problems, or a loss of appetite. Thus, the mood fades into the background. They more frequently mention physical complaints such as pain, dizziness, or gastrointestinal problems, shortness of breath, or heart palpitations. Sleep disturbances, loss of appetite, or weight loss are also typical. This makes the diagnosis difficult, as many of these complaints also have physical causes.

Many signs are similar across all individuals. Nevertheless, women and men often show different areas of emphasis. This overview helps to spot warning signs faster. It is not a fixed rule or a rigid category. Symptoms can overlap. What remains crucial is: anyone who suffers for a longer period of time should receive medical help.

Mood

• Women (common signs): Sadness, crying, withdrawal
• Men (common signs): Irritability, inner restlessness, "staying tough"

Body

• Women (common signs): Loss of appetite, sleep disturbance, pain
• Men (common signs): Blood pressure fluctuations, pain, sleep disturbance

Behavior

• Women (common signs): Avoiding contacts
• Men (common signs): Increased alcohol consumption, risky behavior

Thinking

• Women (common signs): Brooding, feelings of guilt
• Men (common signs): Brooding, hopelessness

There is never a single reason. Most of the time, several triggers work together. These include physical illnesses, limiting pain, inflammation, being overwhelmed by caregiving duties, grief after losses, loneliness, and hearing loss. Medications can also lower the mood. The risk increases when several of these factors come together.

Good news: Even when many factors coincide, effective help is available. Talks, activation in daily life, exercise, social support, and medications if needed can significantly improve the situation—even in old age.

Depression and dementia can look similar. Both can lead to a lack of drive, withdrawal, and problems with remembering. However, there are clear differences:

• Course: In depression, memory and orientation fluctuate: good and bad days alternate. In dementia, memory and orientation usually decrease steadily.
• Self-awareness: People with depression are often very aware of their problems and suffer greatly because of them. In dementia, the awareness of one's own problems is often lower, especially as the condition progresses.
• Onset: Depression can set in quickly, for example after a loss. Dementia develops slowly over months to years.

Anyone who wishes to make an initial assessment for themselves or for relatives can take a self-test or short test. The patient questionnaire "Patient Health Questionnaire" (PHQ-9) is a brief questionnaire with 9 questions regarding mood, sleep, drive, and thoughts. It provides an initial indication of a possible depression and can be downloaded, printed out, or filled out on a screen. It does not replace a medical diagnosis.

• Medical Steps: First, a discussion takes place with the patient’s general practitioner. They will also check for physical causes, such as thyroid function, vitamin deficiencies, anemia, medication side effects, and sensory impairments. This rules out that the complaints are purely due to a physical disorder. Finally, the doctor assesses whether it is a depression and—if so—the level of severity. Then, they will discuss treatment, usually a therapy or a combination of therapy and medication.
• Talks and Behavioral Therapy: The goal is to get back into a daily routine, break down tasks into small steps, interrupt brooding loops, and strengthen sources of joy. In old age, treatment often starts with activation in daily life: short walks, small goals, fixed times of the day. This is effective and safe.
• Exercise: Regular, adapted exercise improves mood, sleep, and drive. Even brisk walking or light strength training several times a week helps. Doctors can recommend exercise therapy.
• Medications: Antidepressants can help when talks and activation alone are not enough. The selection depends on accompanying illnesses and other medications. Starting with a low dose and increasing slowly is standard practice in old age.

Digital Health Applications (DiGAs) are approved online programs prescribed by a doctor and covered by health insurance. deprexis is one such online program for treating depression. It guides you through short, clear steps based on proven therapeutic methods. You work independently on your smartphone, tablet, or computer. Usage is usually designed for 90 days. deprexis is CE-marked and approved for use as a medical device.

How deprexis Helps—in a Practical Way

• Guided conversations: You click through short dialogues. The program adjusts the next steps based on your answers.
• Exercises for daily life: Worksheets and audio exercises strengthen structure, activity, and helpful thoughts.
• Self-monitoring: You log your mood and activities and recognize connections.
• Staying on track: Reminders via email or SMS help you stay on the ball.
• With or without guidance: deprexis can be used with or without a combination of medical or psychotherapeutic treatment.

Prevention does not mean having to train everything away. It is about small steps that you can manage regularly. A fixed routine provides support and takes the chaos out of the day. This recreates moments that feel good. It is better to plan a little and stick with it than to overwhelm yourself. If something does not work out, it is not a setback, but an invitation to start even smaller.

Daily Structure

• Fixed times: Waking & getting up, meals, exercise, contacts—recurring.
• 1-minute start: Make tasks so small that getting started is easy.

Exercise and Body

• Walking and light strength training: Several times a week, adapted to your capabilities.
• Sleep: Keep daytime naps short, dim lights in the evening, put devices away earlier.

Social Life

• Maintaining contact: Short phone calls, neighborhood gatherings, senior groups, volunteering.
• Accepting help: Domestic help, transport services, hearing aid adjustment—small reliefs with a big impact.

Enjoyment and Meaning

• Reviving old hobbies: Music, gardening, handcrafts, cooking together.
• Gratitude note: Note down three good things in the evening—small details are enough.

Taking Warning Signs Seriously

• If joy stays away: If sleep and appetite are poor, or feelings of guilt grow, schedule a medical appointment.
• In case of suicidal thoughts: Dial 112 or go to the emergency room.