Depression is the most common mental health problem of older people. It is
a serious disorder which can lead to persistent suffering, increased mortal
ity, from both suicide and general medical causes, and poorer: overall heal
th. Although presenting symptoms are similar in all age groups there are di
fferent aetiological pathways. In older people the waning effect of genetic
predisposition to affective disorder may be replaced by subcortical brain
abnormalities of presumed vascular aetiology. These may influence prognosis
. Depression in later life is often under-diagnosed and under-treated; thes
e two factors are the main hurdles to an improved prognosis. Antidepressant
treatment should be tailored to the patient and works best when combined w
ith psychological therapy, but the latter treatment modality is woefully ne
glected in later life psychiatry. Improvements in prognosis are unlikely to
come from new revolutionary treatments but from vigorous treatment in the
acute phase, continuation after recovery for at least 12-18 months and long
-term maintenance treatment for those at high risk of recurrence.