Diagnosing and Treating Depression in the Elderly

As the population of people over 65 years of age increases, clinicians will see more cases of latelifedepression. Currently, the rates of depression in the elderly are higher for nursing home patientsand other medical inpatients and outpatients than for the noninstitutionalized, non-medically illelderly. Depression in the elderly may be difficult to diagnose because of factors such as late onset,comorbid medical illness, dementia, and bereavement, but depression is not a natural part of aging.People who are depressed have increased suffering, impaired functioning, and increased mortality.Fortunately, antidepressants have been shown to effectively treat late-life depression. While monoamineoxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) are efficacious for treatingdepression in the elderly, their side effect profiles may be difficult and even dangerous for some olderpatients. However, serotonin selective reuptake inhibitors (SSRIs) and other second generation antidepressantsappear to be both effective and better tolerated in the elderly. Since elderly patients maybe more sensitive to drugs, clinicians may need to closely monitor these patients for dosing, side effects,and drug-drug interactions.