CURRENT ISSUES IN THE TREATMENT OF MAJOR DEPRESSION

Major depression is a common psychiatric disorder associated with cons iderable suffering for individuals and their families. Indeed, the Med ical Outcomes Study reported that the degree of physical and social im pairment and the use of health care resources among patients with diag nosable depressive disorders is comparable only to that with chronic c ardiac disease. In addition, recent studies in the United States and b y the Cross-National Collaborative Group suggest that the cumulative l ifetime incidence of major depression is increasing, with the more rec ent birth cohorts at increased risk. Unfortunately, major depression r emains an underdiagnosed and undertreated condition. Evidence from the National Institute of Mental Health (NIMH) Collaborative Depression S tudy suggests that significant numbers of depressed patients receive l ittle or no antidepressant therapy, despite the availability of effect ive treatments. Data from the NIMH Collaborative Depression Study furt her indicate that depression is a chronic and recurrent disorder. The diagnosis and treatment of depression in the elderly remain a signific ant challenge. Concomitant medical illness frequently obscures the dia gnosis, and as a result, large numbers of depressed elderly go untreat ed. Although there is evidence that pharmacotherapy generally is as ef fective in the elderly as in younger adults, problems with side effect s and compliance may limit the usefulness of some agents. Further inve stigation is needed to evaluate the effectiveness of antidepressant dr ugs in the very old and in those with concomitant medical illness.