"The older we get, the more reasons there seem to be for feeling sad. Most of us have retired, losing the day-to-day routine of work that has filled our days for years. Our children are grown, and some of them have moved far away. Many of us have lost our parents, and now, we are beginning to face the reality that we are going to lose siblings, friends and even spouses as the years go by."

Have you ever felt that way? No one can deny that loss creates sadness. It is totally appropriate to react with deep sadness to the major losses in one's life. But where is the line drawn between the sadness of loss or grief and depression that needs the attention of a doctor?

There are people who think that depression is something that happens to you as you age, just as your skin begins to wrinkle or you tire more easily. This is not true. Some may think that depression is the response to physical illness. But there is a difference between feeling sad or upset and being clinically depressed. It is important to understand this difference. Even family physicians are not always aware that a patient may be exhibiting symptoms of depression. The older person himself may not admit feeling depressed.

A depressed person experiences overpowering sadness that lasts for more than a few weeks. He feels hopeless and is overwhelmed by great anxiety and irritability. He may lose interest in the activities that he normally enjoys, have trouble sleeping or sleep too much, have no appetite or eat all the time. He may feel all sorts of aches and pains. He feels generally sluggish and has trouble concentrating. He may also talk about wanting to die or having nothing to live for.

Because older people are expected to slow down, the sluggishness of depression is often not noticed. Since they are more likely than younger people to have other physical problems or illnesses their doctors may focus on these and not notice the depression. But treating depression is as important as treating other illnesses. A depressed person can feel better. There are medications and other types of treatments that work. If you think you are depressed, please talk to your doctor. It is important to get a full physical examination and explain exactly how you have been feeling. Your doctor will want to know about all of your symptoms so that he can better determine how to help you. He may also send you for tests or refer you to other doctors to decide on the best treatment.

Sarah is an 82-year-old woman who lives alone in her own apartment. She remained active and involved with community activities since her retirement at 65 from her career as a schoolteacher. However, since the death of her husband Philip two years ago, she has been having dizzy spells and aches in her legs. She doesn't eat much and is losing weight. When her daughter Maggie visits, she complains that she cannot sleep at night. Every little noise frightens her. She has discontinued her community activities, hardly sees her friends or neighbors and spends much of her time staring out the window. When Maggie or her brother Bob come to visit, they often find her sitting at the dining room table and crying. Maggie is beginning to wonder if her mother should still be living alone. Should she invite Sarah to live with her or maybe consider finding a nursing home for her?

Theodore is a seventy-four year old man. He is married to Maxine, who is ten years younger than him and truly the love of his life. In addition, his life had been devoted to music. He retired at sixty-nine from an illustrious career as a violinist with the Philadelphia Symphony Orchestra. He would still be performing if he hadn't developed arthritis in his hands. He can no longer play. The first few years after he retired, he pushed himself to walk and swim to stay in shape, but he didn't keep it up. His wife, Maxine, pampered him with fancy lunches and brought him books to read and CDs to listen to, but she was often busy with her own life. She taught art part time, went to yoga, her book club, had coffee with her friends. He was bored, felt more and more alone, and as time passed he became depressed. Instead of relaxing when he listened to classical music, he felt anxious and angry. He even snapped at Maxine for being too young and active. When she suggested he talk to their doctor about his moods, he blew up. Talk to the doctor? It was enough to have to talk about his arthritis with him. Anyway, their doctor was young and handsome. What would he know of getting old?

Both Sarah and Theodore have experienced loss. Sarah is grieving for Philip, but she is also grieving for her own life with Philip, her marriage and life the way she knew it for almost sixty years. Theodore has a loving wife and is younger than Sarah. He became depressed after a different type of loss, the loss of his ability to play the violin. Theodore is grieving the loss of his art, his creativity. Life has become a meaningless abyss.

Maggie discussed her mother's situation with her own doctor who encouraged Maggie to bring Sarah to a specialist in geriatric medicine to be evaluated. In Theodore's case, his wife Maxine finally convinced him to see their family doctor.

A geriatric specialist or a family physician should be the one able to determine what is the best way to treat the depressed person. If for any reason, you feel that your doctor is not helping you, there is no reason why you cannot go to another one. It's important to feel comfortable with your doctor and to trust him as being the right doctor for you.

There are different ways to help people like Sarah and Theodore. Sarah's geriatric specialist put her on a low dose of antidepressant medication and counseled her children to take her out to dinner, to visit family members. He encouraged Sarah to join a golden age club at the community center or participate in church activities, where she would spend time with people. He requested that she make an appointment to see him in two weeks, when he would determine whether she also needed to see a psychiatrist.

Maxine finally convinced Theodore to see their family doctor. Their doctor felt that Theodore might be helped without medication and he worked with him to plan an exercise program, which included daily walks and swimming in the community pool in the mornings. The exercise would be good for his arthritis as well as his mood. He also gave Theodore the phone number of a social worker in the area that specializes in helping older people and made him promise to make an appointment. His doctor felt that discussing his feelings and frustrations on a regular basis would be helpful to Theodore. He also requested that Theodore return in two weeks.

The depressed person not only perceives the world "through a glass darkly." He experiences physical as well as emotional symptoms. But there are ways to fight depression. It shouldn't be assumed that depression is the fate of the aged. Both old and young deserve the best possible quality of life.