Depression in later life: what a psychiatrist and a psychotherapist say about symptoms and treatment

Depression is not merely a passing feeling of sadness, but a mental health condition characterised by intense, long-lasting emotional symptoms that can seriously affect everyday life – from professional performance to family relationships and the ability to care for oneself. Psychiatrist Mihai Zanfir and psychotherapist Liviu Elefterie discussed this topic on the programme Timp pentru Sănătate, broadcast on Prima News TV by Profit.ro every Wednesday at 5:00 PM.

What depression actually means

According to Mihai Zanfir, the term "depression" is often used loosely, but in mental health it involves several specific components: persistent sadness, a continuous sense of suffering and discomfort, and difficulty experiencing joy. "When we talk about depression, we're talking about problems of an emotional nature – feelings such as sadness, a continuous sense of suffering, discomfort, and difficulty feeling joy," the psychiatrist explained.

What sets depression apart from an ordinary period of sadness is the intensity and duration of the symptoms, as well as their impact on daily life. A clear benchmark is duration: "The clinically significant duration – the point at which a person should start asking questions – is two weeks," Zanfir noted. He added that isolated depressive episodes can occur, as can depressive disorders in which these episodes recur over time.

Impact on everyday life, including for older adults

Depression can reduce professional performance, motivation, and concentration, and can affect family relationships or academic functioning. In older adults, difficulties may extend to managing medication correctly.

Liviu Elefterie has observed in his practice that people with depression frequently complain of low energy, deteriorating relationships with friends and colleagues, and a loss of pleasure in activities they previously enjoyed. Many people come to psychotherapy only after having tried several solutions on their own: "I tried this, it didn't work; I tried that, it still didn't work – and then they come to the practice. (...) What is certain is that they feel a constant pain and a profound inability to see the light at the end of the tunnel," the psychotherapist said.

Physical and cognitive symptoms

Depression is not limited to the emotional realm. Mihai Zanfir explained that physical symptoms may also arise – such as non-specific pain, even in the absence of a clear medical cause – and that an existing condition may be experienced as more intense.

These are accompanied by sleep disturbances – insomnia, restless or fragmented sleep, or waking very early in the morning – as well as changes in appetite: reduced appetite and weight loss in some individuals, or increased appetite and weight gain in certain atypical forms. Irritability or nervousness may also occur. "Other manifestations can indeed include disrupted sleep – insomnia, restless sleep, fragmented sleep, or conversely, waking very early in the morning and getting insufficient sleep overall. This, of course, further contributes to the lack of energy the person may experience," Zanfir elaborated.

The psychiatrist also mentioned cognitive symptoms, such as difficulties with attention and concentration. In older adults, this can cause confusion: chronic depression may be mistakenly interpreted as the onset of a neurocognitive disorder. Furthermore, depression can affect one's sense of self-worth and self-esteem.

How psychotherapy helps

Liviu Elefterie explained that in his practice he focuses on reducing self-criticism and fostering self-compassion. People with depression tend to interpret difficulty performing even simple tasks as personal failure, which further undermines their self-esteem.

"What we try to do in the practice is help people understand that it's OK to make mistakes sometimes. That it's OK to be vulnerable. That it's OK to be unable, at times, to get out of bed – because for someone living with depression, the cost of doing so is entirely different from what it would be for someone without depression," the psychologist said.

The connection with ADHD

The two specialists also addressed the link between depression and ADHD. Mihai Zanfir highlighted that the attention difficulties, professional or academic performance problems, and relationship difficulties associated with ADHD can accumulate over time, particularly when the condition remains undiagnosed.