Diagnosing and treating depression in the elderly

As the population of people over 65 years of age increases, clinicians will see more cases of late-life depression. Currently, the rates of depression in the elderly are higher for nursing home patients and other medical inpatients and outpatients than for the noninstitutionalized, non-medically ill elderly. 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 monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) are efficacious for treating depression in the elderly, their side effect profiles may be difficult and even dangerous for some older patients. However, serotonin selective reuptake inhibitors (SSRIs) and other second generation antidepressants appear to be both effective and better tolerated in the elderly. Since elderly patients may be more sensitive to drugs, clinicians may need to closely monitor these patients for dosing, side effects, and drug-drug interactions.