[Clinical aspects of the depression in the elderly]

Depression is the most frequent psychiatric disorder in the aged and a major cause of dependence. Its prognosis is poor on account of its consequences on physical health, the risk of suicide and of chronic evolution. It severely impairs the quality of life of the patients and makes a major contribution to the cost of public health since depressed subjects are hospitalized and use medical care more frequently than non depressed patients. However, they do not receive proper treatment for their depression. There is a large agreement on the necessity to improve the diagnosis of depression in the aged and to provide its adequate management. The difficulty of its diagnosis is not related to some specificity of depression but to the attitude of physicians toward aging. The recent guidelines for the diagnosis of depression insist on the indepency of the criteria regarding to age. The specificity of depression in the aged is only related to some clinical aspects and factors related to aging which interfere with its recognition, especially significant somatic complaints, cognitive disturbances and anxiety. Depression is no part of normal aging, but many risk factors are associated with aging, especially bereavement. A close clinical approach is required to distinguish depression from bereavement.