Clinical practice guidelines for management of depression in elderly

INTRODUCTION Depressive disorders are one of the common psychiatric ailments seen in elderly population. As per the World Health Organization (WHO) prevalence of depressive disorders among elderly is 10 to 20%. Data from India reveals a wide variation in the prevalence rate of depression. Prevalence in community-based studies have varied from 8.9% to 62.16% and clinic based studies have estimated the prevalence of depression to range from 42.4 to 72%. Unfortunately, depression among elderly is often considered as part and parcel of life and is under-recognised and under-diagnosed. Depression in elderly has been shown to be associated with significant negative consequences ranging from poor quality of life, difficulties with activities of daily living, physical comorbidities, premature mortality and cognitive impairments. Although the incidence of depression among elderly is similar to that reported in adult population, depression in elderly is associated with higher risk of suicide, more frequent hospitalization, higher number of consultations with the treatment agencies and family burden. Hence, it is very important to recognise depression among elderly and manage the same. Timely recognition and adequate management of depression among elderly can lead to improvement in quality of life, maintaining optimal levels of function and independence, reduction in morbidity, reduction in mortality due to suicide, development of medical illnesses and treatment costs. Indian Psychiatric Society (IPS) published Clinical Practice Guidelines (CPGs) for management of depression among elderly, for the first time in the year 2007. IPS also published revised CPGs for management of depression in adult patients in the year 2017. Current version of the CPGs is an update of the earlier version of CPGs for management of depression in elderly. The current version of the CPGs for depression in elderly must be read in conjunction with the previous version of CPGs for depression in elderly and revised CPGs for management of depression in adult population. These guidelines provide a broad framework for assessment, management and follow-up of elderly patients presenting with depression. Most of the recommendations made as part of the guidelines are evidence based. However, these guidelines should not be considered as a sustitute for professional knowledge and clinical judgment. The recommendations made as part of these guidelines have to be tailored to address the clinical needs of the individual patient and treatment setting. DIAGNOSTIC COMPLEXITIES OF DIAGNOSING DEPRESSIVE DISORDERS IN ELDERLY Depressive disorders in elderly can include a spectrum of disorders (Table-1). Depression in elderly is also known as late life depression, which is further understood as late onset depression and early onset depression. There is lack of consensus on the age cut-off used to define late onset depression, with some of the authors considering the age cut-off of 60 years, whereas others define it as experiencing first episode of depression ≥ 65 years of age). While assessing depression among elderly, it is important to remember that although many elderly have depressive symptoms, they do not fulfil the criteria of major depression. 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