Diagnosis and Treatment of Depression in Late Life

Major depression and dysthymia are common and often disabling disorders in late life. Severalfeatures of late-life depression, such as its frequent association with general medical conditions,polypharmacy, cognitive disturbances, and adverse life events, make accurate diagnosis a substantialclinical challenge. Yet, prompt diagnosis is an important component of implementing appropriatetreatment strategies. An ideal treatment program integrates patient and family education, focused psychotherapy,and pharmacotherapy. Because of pharmacokinetic and pharmacodynamic changes associatedwith aging, lower doses of medication and more gradual dose increases than are required inyounger adults are needed in the treatment of elderly depressed patients. In addition, medicationsshould be selected that have minimal antihistaminic, anticholinergic, and antiadrenergic effects, minimalcardiovascular risk, and minimal drug-drug interactions. Since depression in late life tends to beat least as chronic and/or recurrent as depression earlier in life, treatment for acute depressive episodesshould last at least 6-8 months, and long-term maintenance treatment should be considered inselected individuals.