The symptoms may have no clear cause and may resolve spontaneously, and episodes may occur in increasingly rapid cycles. Adjusting to a severe or ultimately fatal chronic illness and losing a spouse or partner are common causes of such symptoms. Affected persons recover with time or when the stressor resolves. Symptoms must persist for at least 2 years but are not severe enough to constitute a major depressive episode. Sometimes major depression is characterized predominantly by psychotic features, especially delusions of illness or guilt about past actions, thoughts, or events.
Psychotic depression is more prevalent in late life than in midlife.
Generally, psychotic symptoms are similar among elderly and younger patients, although elderly patients usually have more of them and are less likely to experience self-deprecation and guilt. Bipolar I disorder is characterized by one or more manic episodes, with or without episodes of depression. Manic episodes may occur for the first time in late life but most often recur from an earlier age. During a manic episode, a person may experience an inflated self-esteem, decreased need for sleep, increased talkativeness, a subjective sense that thoughts are racing, distractibility, psychomotor agitation, and involvement in activities that are perceived to be pleasurable but that can lead to adverse outcomes, such as unrestrained buying. Elderly persons are less likely to experience inflated self-esteem or grandiosity during an episode and are more likely to experience irritability and psychomotor agitation, thus making it somewhat difficult to distinguish a manic episode from agitated depression.