Depression in The Elderly:  A Homoeopathic Approach to Geriatric Mental Health

Abstract

Late-life depression represents one of the most prevalent neuropsychiatric conditions affecting the elderly population, often coexisting with medical comorbidities and cognitive decline. Late‑life depression affecting those aged 60+ is a common yet underrecognized mental health issue. It can begin for the first time in later life or recur, often coexisting with chronic illness, cognitive decline, and life stressors. LLD severely impacts quality of life and increases risks of morbidity and mortality. Despite this, it frequently goes undiagnosed due to overlapping somatic symptoms and stigma. Unfortunately, regular antidepressant medicines often don’t work well in older people and may cause side effects. Because of this, newer and safer options, such as brain stimulation therapies, natural or alternative treatments, have shown positive results. Among these, homeopathy has emerged as a gentle and individualized approach to treating late-life depression. It focuses on the person as a whole, considering not just the emotional symptoms but also the physical and mental state of the patient. This article reviews the prevalence, ICD‑10 diagnostic criteria, clinical features, repertorial approach, and homoeopathic management.

Keywords: Late life Depression, Homoeopathy, Mind Rubrics.

Introduction

Depression that occurs among individuals greater than or equal to 65 years with no previous history of depression is known as late-life depression, which is characterized as the affective state of sadness that occurs as a response to various human situations including loss of a loved one, failing to achieve goals, or disappointment in love relationships. Major depressive disorder is clinically characterized by a more intense, prolonged, and pervasive disturbance in mood that significantly impairs daily functioning, distinguishing it from transient emotional states. It commonly coexists with physical illnesses (e.g., diabetes, heart disease) and cognitive disorders (e.g., dementia)—factors like bereavement, retirement, and declining health compound the problem. Left untreated, it can worsen daily functioning, cognition, and even increase the risk of suicide and institutionalization. In 2019, adults over 65 made up over 9% of the global population, projected to reach 16% by 2050. Given rising psychosocial and environmental stressors, their physical and mental health requires focused clinical attention.

Epidemiology

The prevalence of LLD significantly varies worldwide. Recent epidemiological meta-analyses involving 57,486 older adults showed that the average expected prevalence of LLD is 31.8%. Subgroup analysis revealed a significantly higher pooled prevalence of depression in developing countries (40.78%) compared to developed countries (17.05%), indicating a greater mental health burden in low-resource settings. Community–dwelling elderly: 1–5% have Major Depressive Disorder; up to 15% have minor depressive symptoms, Primary care: – 10% present with clinically significant depression, Institutional/nursing homes: 30–50%, often more severe or treatment-resistant, Hospitalized elderly: 20–25%, especially those with illness.

Pathophysiology

The pathophysiology of depression involves multiple brain regions responsible for mood regulation. These include the frontal cortex (attention and thinking), hippocampus (memory), nucleus accumbens (emotional response), hypothalamus (sleep, appetite, energy, and libido), and key brainstem areas like the ventral tegmental area, dorsal raphe nucleus, and locus coeruleus, which send important chemical signals such as dopamine, serotonin, and noradrenaline. In depression, these systems become dysregulated. In late-life depression (LLD), common contributing factors include reduced levels of monoamine neurotransmitters, increased inflammation, abnormal glutamate activity, reduced neurotrophic support, and altered stress hormone regulation via the HPA axis. Additionally, age-related brain changes such as amyloid-beta buildup and reduced gut microbiome diversity may play a role, especially when cognitive symptoms are present.

Diagnostic Criteria (ICD‑10, F32)

Core symptoms (≥2 required):  

1. Persistent depressed mood  
2. Loss of interest or pleasure  
3. Low energy/fatigue  

Additional symptoms (total ≥4 with core):  

– Reduced concentration  

– Low self-esteem and confidence  

– Ideas of guilt and unworthiness  

– Pessimistic views of the future  

– Suicidal thoughts or acts  

– Sleep disturbances  

– Diminished appetite

Severity specifiers:  

– Mild (F32.0): 2 core + 2 additional  

– Moderate (F32.1): 2 core + 3–4 additional  

– Severe (F32.2): 3 core + 4+ additional; may include psychotic features  

In older adults:  

– Often present with somatic complaints  

– Less likely to report sadness directly.

Key Diagnostic Tools for Depression in Old Age

1. Geriatric Depression Scale (GDS)

• Designed specifically for older adults.
• Simple yes/no format (15 or 30 questions).
• Minimizes emphasis on physical symptoms, which may overlap with aging.

2. Patient Health Questionnaire (PHQ-9)

• Standard tool based on DSM criteria for depression.
• Easy to use in clinical practice.
• Useful for both diagnosis and monitoring progress.

3. Hamilton Depression Rating Scale (HAM-D)

• Clinician-administered.
• Covers mood, anxiety, sleep, and somatic symptoms.
• Widely used in research and hospital settings for severity rating.

Treatment and management of Late-Life Depression

• Pharmacological Treatment of LDD

• SSRIs (Selective Serotonin Reuptake Inhibitors):

• First-line treatment for LLD.
• Common options: sertraline, escitalopram, fluoxetine.
• Elderly-specific side effects: hyponatremia, akathisia, anorexia, sinus bradycardia.

• SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors):

• Second-line treatment.
• Includes: venlafaxine, desvenlafaxine, duloxetine.
• Generally safe in older adults.

• Atypical Antidepressants:

• Includes: bupropion, mirtazapine.
• Mirtazapine: Helpful for depression with insomnia, poor appetite, or restlessness.
• Considered a second-line option.

2. Non-Pharmacological Treatment of LLD

• Electroconvulsive Therapy (ECT):

• Highly effective in elderly patients.
• Used when depression is resistant to medication and/or psychotherapy.
• Safe and well-supported by clinical evidence.

• Transcranial Magnetic Stimulation (TMS):

• Uses magnetic fields to stimulate brain activity.
• Non-invasive and effective for LLD, especially in cases not responding to medication.

• Light Therapy:

• Exposure to specific wavelengths of natural or artificial light.
• Reduces depressive symptoms and improves sleep in elderly, especially in care homes.

 

3. Psychotherapy in Late-Life Depression (LLD)

• Psychotherapy can moderately improve symptoms of depression in older adults.
• The benefits often last for 6 months or more after treatment.

Common evidence-based therapies include:

• Cognitive Behavioral Therapy (CBT):
  Helps patients recognize and change negative thinking patterns and behaviors.
• Problem-Solving Therapy (PST):

Helps develop practical coping skills to handle everyday problems and lower stress levels.

• Interpersonal Therapy (IPT):
  Focuses on improving relationships and social support.
• Life Review Therapy:
  Involves reflecting on past life experiences to find meaning and cope with current emotions.

 

4. Lifestyle & Social Support  

-Healthy lifestyle habits, including regular physical activity, a balanced diet, and strong social support, can be a cost-effective way to improve overall well-being in older adults. These factors may help prevent or manage late-life depression.

Homeopathic Therapeutic Management

Homoeopathy offers effective treatment for depression in elderly individuals by adopting a holistic approach. Unlike conventional medicine, which often targets only the localized symptoms and may suppress the disease, homoeopathy considers the patient as a whole, addressing both mental and physical aspects based on individual constitution. In contrast, modern medicine may provide only partial or temporary relief, often requiring long-term medication and sometimes resulting in additional health complications. A perfect homoeopathic similimum chosen by proper case taking can be helpful in managing depression in elderly people.

1. Sepia

Characterized by sadness with frequent weeping, Sepia individuals often show aversion to loved ones, emotional indifference, and a marked preference for solitude. Depression tends to arise from hormonal imbalances, caregiving burdens, or chronic fatigue. Their condition worsens with consolation, which they actively reject. Especially suited for women—often during menopausal or postpartum periods—who feel emotionally drained and disconnected.

2. Aurum Metallicum

Deep, profound melancholy with suicidal ideation and a tendency toward religious despair. Ideal for those who are driven, perfectionist, and career-oriented—especially men—who experience emotional collapse following failure, retirement, or personal loss. They suffer from intense self-criticism, guilt, and feelings of worthlessness. Depression in Aurum is often masked by outward responsibility and duty.

3. Natrum Muriaticum

Suited to those who suffer in silence, unexpressed grief and emotional pain. These individuals often revisit past trauma or humiliation, yet avoid displaying vulnerability. They are very sensitive but reserved, maintaining a composed exterior while struggling internally with sadness, anger, and attachment. They avoid comfort or consolation and often prefer solitude. Natrum Muriaticum is one of the most effective remedies for long-standing, unresolved emotional grief.

4. Ignatia Amara

Best suited for acute grief, emotional shock, or sudden bereavement. The person displays dramatic emotional changes—sighing, sobbing, a sensation of a lump in the throat, or hysterical laughter or crying without clear reason. Highly sensitive and idealistic, they internalize emotions yet can be unexpectedly reactive. Ignatia is useful when grief is recent and unprocessed, especially when the person tries to maintain composure externally.

5. Pulsatilla Nigricans

A deeply emotional and dependent personality, often tearful and desiring sympathy and affection. Depression is marked by mood swings, emotional clinginess, and a strong need for reassurance. They feel better in the open air, with gentle consolation, or after weeping. Often suited for soft-natured, yielding individuals—particularly elderly women—who feel neglected or abandoned. Pulsatilla’s mood improves with companionship and tenderness.

 

6. Lycopodium Clavatum

Low self-esteem masked by a need to appear competent and in control. Lycopodium types fear failure and public embarrassment, often overcompensating by being domineering or critical. Depression stems from pressure to succeed and internal self-doubt. Common symptoms include digestive issues and worsening of mental symptoms between 4–8 PM. Despite a façade of confidence, they often struggle internally with inadequacy and anxiety.

7. Arsenicum Album

Perfectionist and highly anxious individuals who fear death, disease, or disorder. Depression is rooted in insecurity, a compulsive need for control, and fear of losing order. Restlessness, fastidious behaviour, and hypersensitivity to illness are prominent. Arsenic is especially suited for those who experience profound mental distress when things are not ideal, and who may be highly critical of themselves and others.

8. Calcarea Carbonica

Marked by mental and physical sluggishness, fear of insanity, and a deep sense of insecurity. Typically suited to individuals who are overburdened, responsible, yet easily overwhelmed. They may be overweight, chilly, and experience fatigue, confusion, and emotional withdrawal. Calcarea is helpful for those who fear losing control, especially under work-related stress. It also addresses associated insomnia, anxiety, and apathy.

 

Repertorial Approach 

Repertorial totality is very important in selecting the right medicine. In homoeopathy, you don’t just treat the name of the disease—you match the patient’s symptoms with those found in the Repertory. Each well-proved remedy has thousands of symptoms, and it’s not possible for a practitioner to remember them all or to connect each one directly to a remedy. This is where the Repertory helps. It acts as a bridge between the Materia Medica and the patient’s condition. A Repertory is a well-organized, systematic index of symptoms that guides us toward the most suitable remedy.

Kent’s Repertory	Synthesis Repertory
Mind – Sadness	Mind – Depression – old people
Mind – Brooding	Mind – Delusion – worthless
Mind – Grief	Mind – Weeping – involuntary
Mind – Ailments from grief	Mind – Grief – ailments from
Mind – Aversion to company	Mind – Fear – death, of
Mind – Desire for solitude	Mind – Memory – weak in old people
Mind – Suicidal disposition	Mind – Fastidious
Mind – Anxiety about future	Mind – Abandoned
Mind – Despair	Mind – Sadness
Mind – Indifference	Mind – Restlessness
Mind- Loathing, life	Mind – Abashed

 

Conclusion

Late-life depression is a treatable and preventable disorder. Homoeopathic remedies aim to restore balance in the body and mind, strengthen overall vitality, and reduce the root causes of depression without the risk of side effects, making it especially suitable for older adults.  Prompt recognition, comprehensive treatment, and follow-up care can vastly improve prognosis and functioning in older adults. A homeopathic approach, especially when individualized and integrated with standard treatment, can offer substantial relief and emotional balance, particularly in mild to moderate cases.

 

References

International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO), ‌2019/2021.

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