Geriatric Depression

Depression in the elderly is more common than once thought, especially in nursing home settings, where as many as 25% of residents can exhibit signs and symptoms of depression. Depression in the elderly can have a significant impact on overall health and desired outcome. The depressed elderly patient has been shown to have worsened prognosis of concomitant medical conditions, increased use of health care, decreased recovery time, and more likelihood to experience accelerated physical deterioration. Suicide represents the most serious complication of depression of the older depressed individual. The elderly are at a disproportionate risk for suicide attempts and are more likely to be successful. Diagnosis should be made using Diagnostic and Statistical Manual of Mental Disorders(4th ed.) (DSMIV) criteria, and clinicians should use standardized rating scales such as the Geriatric Depression Scale to assist in monitoring the severity of depressive symptoms and the efficacy of antidepressant treatment. Several treatment options are available to the clinician and include psychotherapy, electroconvulsive therapy, older antidepressants such as the tricyclics, and newer more tolerable therapies such as the serotonin reuptake inhibitors. Drug therapy should be individualized and should take into account the pharmacokinetic and pharmacodynamic changes that are associated with normal aging.