Assessment is the vital first step in management of late-life depressi
on. Somatic treatments are more likely than psychological approaches t
o be effective in relieving melancholia, psychotic depression and bipo
lar depressive swings. However, if severe depressions are associated w
ith brain changes (eg. white matter lesions), recovery is less likely
A complex interplay of psychological and organic factors may account f
or depressions associated with medical conditions. Physical handicap h
as a strong association with depression. Psychological and psychosocia
l interventions may be appropriate in managing non-melancholic, loss-r
elated or situational depressions, though antidepressants are also eff
ective in many cases. Research is needed to compare the effectiveness
of antidepressants and non-pharmacological treatments in non-melanchol
ic and 'understandable' depressions. An optimistic and persistent appr
oach will lead to a good and maintained outcome in most cases of depre
ssion, in spite of the losses of old age.