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People tend to think that the telltale sign of depression is sadness鈥攁 pervasive down, dragging feeling that won鈥檛 let up, day after day. But depression often manifests itself as something else entirely鈥攍ike aches and pains or memory lapses.

These 鈥渦nusual鈥� symptoms are actually quite common. They can mask depression鈥攁nd delay an important diagnosis鈥攅specially in older people. 鈥淪ometimes it鈥檚 hard to diagnose depression in older adults because they don鈥檛 come in and say, 鈥業鈥檓 depressed.鈥� They鈥檙e more likely to present with physical symptoms that they don鈥檛 connect with what they鈥檙e feeling鈥�pain, memory problems, poor sleep, a change in appetite,鈥� says Dr. Anne Fabiny, chief of geriatrics at Cambridge Health Alliance and assistant professor of medicine at Harvard Medical School.

She鈥檚 even seen people fall more frequently because they鈥檙e depressed. The connection might not seem logical, until you consider that depression can make people more inattentive to their surroundings.

Older people in particular鈥攁nd older men especially鈥攄isplay their depression in unusual ways. 鈥淥lder men are more likely to present with irritability or grumpiness as a symptom of depression than women,鈥� says Dr. Fabiny. 鈥淪o the stereotype of the grumpy old man could be a sign of a depressed old man.鈥�

from the Centers for Disease Control and Prevention shows that depression is more common among women (10.7% of adult women) than men (7.7% of adult men). And though depression tends to peak between ages 45 and 64, it can emerge at any time of life.

Older men and women with depression often don鈥檛 want to talk about it because their generation still harbors a stigma about mental illness. 鈥淥lder people still have the idea that, 鈥業鈥檓 not crazy. I don鈥檛 want people to think I鈥檓 crazy,'鈥� Dr. M. Cornelia Cremens, assistant professor of psychiatry at Harvard Medical School, told me last year for an article in the Harvard Women鈥檚 Health Watch.

Dr. Fabiny says she often doesn鈥檛 say the word 鈥渄epression鈥� when talking to her older patients. Instead, she鈥檒l use terms like 鈥渟ad鈥� or 鈥渂lue.鈥�

To diagnose depression, she鈥檒l look for signs other than sadness, including:

• trouble sleeping
• lack of energy
• fatigue
• trouble concentrating or remembering
• loss of appetite
• aches and pains that don鈥檛 go away

Because of the stigma, Dr. Fabiny says her older patients are more willing to take medicine to treat their depression than meet with a psychologist or psychiatrist. Yet antidepressants tend to be less effective in older adults, they can take up to three months to start working, and the risk of side effects is greater. 鈥淩esearch has shown that a combination of medication and psychotherapy [talk therapy] is really the most effective,鈥� Dr. Fabiny says.

Any treatment, though, is better than none. Leaving depression to fester and grow can cause repercussions that extend far beyond persistent sadness. 鈥淭here鈥檚 a higher rate of mortality in older adults who are depressed and have untreated depression. And it so profoundly affects quality of life. People suffer鈥攁nd they can also lose functional capacity,鈥� according to Dr. Fabiny. Depression has even been .

If you have one or more of the symptoms listed above that can鈥檛 be traced to an illness or ailment, a frank talk with a trusted doctor about the possibility of depression might be a good step forward.