CLINICAL MANAGEMENT OF THE DEPRESSED GERIATRIC-PATIENT - CURRENT THERAPEUTIC OPTIONS

Depression is probably the most common psychiatric illness affecting t he elderly. Although depression in the elderly usually responds to tre atment, it often goes unrecognized and, left untreated, may lead to co nsiderable morbidity and mortality. Reversible causes of depression (e .g., medications; infectious states; endocrine, collagen, neurologic, and neoplastic disorders; and nutritional deficiencies) must all be ru led out before instituting therapy. Psychotherapy, electroconvulsive t herapy (ECT), and pharmacologic therapy are the main therapeutic appro aches used to manage depression. The pharmacologic options-tricyclic a ntidepressants, monoamine oxidase inhibitors, selective serotonin reup take inhibitors, aminoketones, and triazolopyridines-each appear to be efficacious; however, the side-effect profile of some of the agents m akes them more appropriate for use in elderly patients. It is imperati ve for clinicians, when choosing therapy for elderly depressed patient s, to keep firmly in mind all risks, as well as benefits, inherent in each choice.