Chronic depression in the elderly - Approaches for prevention

Depression in old age frequently follows a chronic and/or relapsing course, related to medical comorbidity, cognitive impairment and depletion of psyc hosocial resources. As endorsed by the US National Institutes of Health (NI H) Consensus Development Conference on the Diagnosis and Treatment of Late Life Depression, a major goal of treatment is to prevent relapse, recurrenc e and chronicity. We believe that most, if not all, elderly patients with major depressive ep isodes are appropriate candidates for maintenance therapy, because of the v ulnerability to relapse and recurrence and because of the favourable benefi t to risk ratio of available treatments. Antidepressant pharmacotherapy is the mainstay of this therapeutic goal, but psychosocial approaches (especia lly interpersonal psychotherapy) have also been shown to contribute signifi cantly to prevention of a chronic depressive illness and to prevention of t he disability that attends depression. Studies published to date have established the long term or maintenance eff icacy of the tricyclic antidepressant nortriptyline. Current, ongoing studi es are addressing the maintenance efficacy of paroxetine and citalopram to prolong recovery in depression associated with old age. These studies are f ocusing particularly on patients aged 70 years and above, who are at high r isk of recurrence, and on patients in primary care settings, where under-re cognition and under-treatment of depression in the elderly have been costly from a public health perspective in terms of increased medical utilisation , burden to patients and families, and high rates of suicide. Depression in old age is a major contributor to the global burden of illnes s-related disability, but it is extremely treatable if appropriate pharmaco therapy is prescribed and accepted by patients and their caregivers.