Recognizing and Treating Depression in the Elderly

Mark D. Miller, MD

Medscape Psychiatry & Mental Health eJournal. 1997;2(2) 

In This Article

Abstract and Introduction

A study of community dwellers estimated that 15% of the elderly showed significant depressive symptoms. A smaller subset (1% to 2%) met criteria for a major depressive disorder. In nursing homes, the prevalence of depression can be as high as 25%. Rates of depression in primary care clinics range from 5% to 37%. Stressors such as chronic pain, medical disability, or the death of one's spouse are more commonly seen in the elderly and can result in a reactive depression. In one study, more than two thirds of suicides in the elderly took place in the context of depression, and 75% of all geriatric patients who completed suicide had seen their primary care physician in the previous month. Antidepressant medication, psychotherapy, and electroconvulsive therapy have all been successful therapeutic approaches in elderly persons with depression. An overview of geriatric depression is presented, with emphasis on the clinical presentation, associated factors, and newer treatment options.

The majority of elderly persons lead active, independent lives and possess the necessary coping skills to adjust to changes in their lives as they age. Guarding against an ageist bias will allow for the greatest objectivity when treating elderly patients. Nevertheless, chronic pain, medical disability, or the death of one's spouse can result in a depressive reaction in any individual, regardless of age, who finds such stressors overwhelming. These stressors are more commonly seen, however, in the elderly. The presence of multiple stressors or the inability to cope can result in an episode of depression.

A consensus conference on geriatric depression was convened at the National Institute of Mental Health in 1991 to pool research efforts to better understand the problem of geriatric depression and to seek improved treatment strategies.[1] On January 20, 1996, a consensus update was held to report and summarize new findings,[2] many of which will be referred to in this text.

We review depression in the elderly, with emphasis on the clinical presentation, associated factors, and newer treatment options that have become available in recent years, based on broad research efforts and a growing body of experience worldwide.

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