Overcoming Loneliness in Later-Life Depression

At 80, Agnes was struggling with depression for the first time. She could handle the moments when she felt “blue” or “down.” She could understand that moving into her new apartment was a change, and that change could be stressful. She could even accept that she was forgetting more things, more often, than usual.

But what she could not stand, just could not get used to, was the loneliness. She thought she’d been through the worst after her husband died, but this was different. Her daughter lived only 10 minutes away, her new neighbors seemed nice enough, but still she felt so completely alone. And the more she told herself how fortunate she was, how grateful she should be for her family and her health, how others had it much worse, … the more deeply lonely she felt.

So what is loneliness exactly? Being lonely is similar to being alone, apart from others, but it is also very different. Think of being alone: Isn't it possible to picture a situation when you’d feel OK being alone, maybe even peaceful? Perhaps you'd be knitting a sweater, or walking along a waterfront, or reading a good book. Some people find solitude helps them think clearly and creatively, without distraction.

Now think of being lonely. Isn’t there a completely different tone to your thinking? Loneliness stems from one’s perception of loss, or absence; wanting someone (perhaps someone special) around and not being able to have that. In that sense, some people describe feeling lonely even when they’re around other people, yearning to connect at a meaningful level but being unable to do so.

Loneliness, of course, is a natural part of being human in our imperfect world, in the same way that sadness and grief are normal, expected responses to life’s losses. Older people tend to experience more of these losses, simply by living longer—loved ones die or move away, physical health declines, homes get sold, dreams drift beyond reach. And the fast-paced, youth-oriented nature of our world makes meeting new people difficult for anyone not comfortable with the internet, let alone for people who are depressed.

The kind of loneliness associated with depression is the loneliness that doesn’t ever seem to go away, and is not necessarily affected by whether or not we’re surrounded by people. It may feel like it follows you around, like a dark cloud. Loneliness may begin as a cause of depression, or it may develop later as a symptom. Regardless of how it starts, loneliness is neither natural nor healthy to feel for any extended period of time, nor is it necessary, given proper attention and treatment.

For Agnes, holidays proved especially lonely. Of course she looked forward to being with her family, and to celebrating with her church community. But the depression seemed to sap so much of her energy and get-up-and-go that her usual preparations wore her out just thinking about them. And partway into the festivities themselves, she found that she couldn’t enjoy being with her loved ones at all. She simply stopped putting on a happy face for the occasion, and really wasn’t present anymore. Instead, she had begun dreading the moment when everyone went home, when she'd be alone again.

Depression works like a thief. It steals away your ability to take comfort from the people who love you, to really hold on to their love and keep it warm inside you. It steals away your connections, isolating you from your loved ones, from your neighbors, even from your God. It steals away your identity, your sense of self, making you feel different from other people. "Nobody else could possibly feel so sad/lonely/empty." And so ashamed of your differentness that it's hard to be with other people and imagine that they might want to be with you.

But there are ways to take back your life from the depression, and to ease your loneliness. The first step is to understand that you’re not “crazy.” Depression is a real illness; it is not a normal part of aging. Every year, approximately two million Americans 65 and older experience some form of depression. Other people do feel some of the same feelings that you do; some people might understand what you’re feeling and thinking.

The second step is to realize that loneliness is a real part of depression—just like waking up at 2:00 in the morning, struggling with your memory, and feeling negative or angry about everything. Loneliness is related to low self-esteem and a negative sense of yourself and your future.

Becoming clear that you are not “crazy” should help turn down the volume on the obsessively self-conscious voice that often plays in depressed persons’ heads. Also helpful is learning to be comfortable in your own skin, and learning to be a good friend to yourself. You might consider taking up practices that increase your ability to be “present” in your life and in your body, rather than stuck in your head and your thoughts, practices such as mindfulness meditation or yoga.

This is also a good time to assess your relationships and your social life in general. Do you have at least one or two good friends, people you can trust? Do you have occasion to be with other people working on a common project, such as volunteering at a soup kitchen or cleaning up a local park? What are some interests that you might like to share with other people, perhaps through a book group, knitting class, spiritual community, or neighborhood improvement project?

Resources abound to help you understand both depression and loneliness. To learn how other people have experienced and coped with loneliness specifically, search your library or the internet. You’ll discover books, stories, poetry, and artwork spanning hundreds of years (at least)—and witness just how universal the presence of loneliness has been in human existence.

If you find that your self-help efforts do not provide enough relief for your depression and/or loneliness, please seek professional help. Many psychologists, clinical social workers, and counselors provide psychotherapy designed both to help you learn to be at peace with yourself and to encourage the development of truly meaningful personal and social connections. Some clinicians also teach classes in mindfulness meditation and other alternative healing practices. In those cases where depressive symptoms are particularly severe or long-lasting, antidepressant medication combined with psychotherapy has been shown to be beneficial, sometimes even life-saving.

How is depression assessed and treated?

by Dr. Bob Campbell
Everyone gets sad or feels down now and then. For the most part, this sadness is not depression; it’s just the normal sadness of life. Grief over the death of a loved one is also not depression, although if prolonged normal grief can become depression. What is depression then? Depression is a much more serious condition than the usual sadness or grief; it can be extremely debilitating, and can even lead to suicidal thoughts or attempts. Depression is also surprisingly common – more than 16% of people in the U.S. will get it at least once in their lifetime (Kessler, 2003) – and there have been many famous people who have suffered with it, including Billy Joel, Woody Allen, and the author William Styron, who called it “darkness visible.”
Someone who is depressed often exhibits symptoms such as low energy, changes in sleep habits, significant mood shifts, loss of interest in activities usually enjoyed, hopelessness, or a change in appetite and body weight (up or down). These symptoms commonly cause missed work, low productivity, and relationship difficulties.
The good news is that depression can be effectively treated, and individuals can get better. It may seem straightforward to recognize depression, but it is best assessed by a professional, so that the most appropriate treatment can be initiated. Antidepressant medications have often been prescribed for people who don’t need them, resulting in significant side effects.
Once depression is diagnosed, it can be treated in a variety of ways. Talk therapy has proven to be quite effective for many people, and comes in various types, including cognitive-behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), psychodynamic therapy, Adlerian therapy, and existential therapy. All of these treatment methods are available at Willow, and can be discussed with your therapist. For more severe levels of depression, antidepressant medication may be needed. Research has shown that most severe depressions respond best to a combination of medication and psychotherapy. Rare treatment-resistant depressions can also be treated with electro-convulsive therapy (ECT), which is administered in a hospital, and which has become much more refined and safe over the last several years.

The bottom line is that depression is serious, but can be treated effectively. At Willow, we are committed to providing you with the latest evidence-based treatments to bring hope and joy back into your life.

(For more detailed information, see Kessler, R.C. et al. (2003) 'The Epidemiology of Major Depressive Disorder: Results From the National Comorbidity Survey Replication (NCS-R)', Journal of the American Medical Association 289 (23): 3095-3105.)