DIAGNOSIS AND TREATMENT OF GERIATRIC DEPRESSION

Geriatric depression is a common psychiatric illness affecting as many as one-third of the older population. With the growing number of elde rly in many countries of the world, the morbidity and mortality associ ated with untreated and partially treated depression is of great conce rn from both a medical and economic perspective. Depression in the eld erly often presents with more somatic or anxious features and less of the subjective sadness expressed by younger groups. In addition, in th e elderly, depressive-spectrum disorders (which include minor depressi on, dysthymia, mixed anxiety/depression, bereavement-related depressio n and even suicidal ideation) are generally under-recognised and under treated by health professionals. The clinical mismatch between high pr evalence but undertreatment stems from patient and physician attitudes toward depression as a 'normal' response to aging and loss, diagnosti cally confusing medical illness-related symptomatology, and noncomplia nce with prescribed treatment. Furthermore, late-onset depression may hold special prognostic value in the elderly, with the relationship be tween late-onset depression and cerebrovascular events and progressive dementing illness being particularly strong. Therapeutically, then ha s been a recent expansion in the pharmacological tools that can be use d to treat depression. A variety of new agents are now available that have adverse effect, pharmacodynamic and target-receptor profiles that differ from the older agents. For example, newer drugs that block the serotonin (5-hydroxytryptamine; 5-HT) transporter have supplanted old er agents that cause more frequent and toxic adverse effects. These ne wer agents have also focused attention on the impact of polypharmacy o n the hepatic cytochrome P450 system, which is responsible for drug me tabolism and elimination. Electroconvulsive therapy and psychotherapy remain effective nonpharmacological treatments for geriatric depressio n. Generally, the opportunities for therapeutic intervention in geriat ric depression suggest that greater diagnostic attention and more wide spread application of treatments for this increasingly prevalent disor der continue to be needed.