[Depression in old age]

At least 4% of elderly patients living in the community suffer from a major depressive disorder and some 15% from less severe forms of depressive illness. However, physical and psychiatric comorbidity is high in elderly patients and the incidence of depression may reach 40% to 50% in common medical disorders such as diabetes mellitus or cardiac insufficiency. Therefore, elderly patients who are hospitalised or living in senior citizen homes suffer more frequently from depressive disorders, with prevalence rates up to 50%. The phenomenology and etiology of geriatric depression are very heterogeneous. Depression often presents atypically, e.g., behind a mask of complaints about physical symptoms or anxiety. Diagnostic and therapeutic measures follow the same standards as in younger adults, yet age-related differences must be taken into consideration. Thus, psychopharmacological management must be adapted to the altered metabolism of drugs in the elderly. Also, psychological treatment strategies should respect the distinctive psychosocial situation of elderly patients.