Somatic therapies in older depressed patients

While psychotherapy is the treatment of choice in neurotic situational depressions of older patients, it is not effective enough in endogenous bipolar or monopolar depression of elderly. These respond better to somatic therapy, mainly pharmacotherapy, or, if necessary, ECT. Experience shows the aged endogenous depressions respond favorably to tricyclic antidepressants as well as to mono-amino oxidase inhibitors, although the dosage may have to be kept lower than with younger patients. ECT, if necessary, is well tolerated and effective in aged patients. However, proper precautions have to be taken before this treatment is commenced. Patients with a history or signs of recent coronary thrombosis or decompensated heart failure should be excluded. Also, the number of treatments should be kept at a minimum. The individual treatments should be spaced farther apart and so-called "intensive treatment" avoided. If an endogenous depression lasts for more than 2 years and does not respond to any other kind of treatment, psychosurgery may have to be considered. Experience has shown that long-lasting, deep depressions of the aged can be helped by this method without any important personality change.