Common causes of depression in the elderly include all of the following, EXCEPT:

• A. prescription medication use.
• B. chronic medical conditions.
• C. alcohol abuse and dependence.
• D. an acute onset of dementia.

Answer: (D)

In older adults, depression is often driven by other health factors rather than arising in isolation. Chronic medical conditions frequently bring pain, fatigue, sleep disruption, and limited activity, all of which can contribute to persistent low mood. Similarly, the medications many seniors take—polypharmacy in particular—can have side effects that include mood changes or depressive symptoms, so prescription drug use is a common contributor. Alcohol abuse and dependence also sit high on the list because alcohol directly affects brain chemistry and can worsen mood, or interact with medical conditions and medications to trigger depressive symptoms.

An acute onset of dementia, however, is not a typical cause of depression. Dementia is a progressive neurodegenerative condition that affects cognition over time; while depressive symptoms can appear in someone with dementia, they are not the primary cause of depression. If cognitive change happens acutely, that pattern is more characteristic of delirium or another sudden brain change, which requires a different evaluation and management. So the exception here is the abrupt onset of dementia.