Assessment and Management of Late-Life Depression

The diagnosis and treatment of late-life depression is often complicated by its clinical context. As a rule, late-life depression afflicts medically ill, disabled persons living under chronic stress and/or isolation. Symptoms and signs of medical illnesses and behavioral limitations from disability are often difficult to distinguish from depressive symptomatology. Under-reporting of depressed mood and other psychological symptoms is common by older adults and contributes to under-diagnosis of depression. Many antidepressant drugs and some psychotherapies have been found more efficacious than their respective comparison conditions. However, each of these treatments helps less than half of depressed older adults, necessitating a treatment strategy in which failure or intolerance of each treatment step informs the next. Clinical subpopulations of late-life depression - psychotic depression, dysthymic disorder, depression associated with an adverse life event, treatment-resistant depression, and residual symptoms of depression - require special attention.