[Atypical presentation of depression in the elderly: fact or fiction?]

Depression in the elderly is often thought to have a different clinical presentation in many patients. This so-called atypical depression is characterised by less sadness and feelings of guilt and more somatic symptoms, impaired cognition and behavioural symptoms. Studies that compare depressive signs and symptoms in elderly and younger patients are reviewed. Published studies do not support the suggestion that major depression in the elderly often have a different clinical presentation. Vascular depression and depression in patients with severe dementia may be exceptions. Conceptual and methodological issues that play an important role are discussed.