MANAGEMENT OF LATE-LIFE DEPRESSION

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.