Psychiatric comorbidity and depression in older adults

Late-life depression rarely occurs in isolation. Thus, screening for and assessment of late-life depression should always involve screening for other psychiatric disorders, including anxiety, personality disorders, and alcohol misuse. Comorbidity often makes treatment to relieve depressive symptoms more complicated, more comprehensive, and longer. Current late-life depression research indicates the strongest support for antidepressant medication and/or cognitive-behavioral therapy for comorbid anxiety, antidepressants and dialectical behavior therapy for comorbid personality disorders, and antidepressants and counseling for alcohol abuse that incorporates specific coping skills training for mood management, based on cognitive-behavioral principles. The clinician should provide sufficient psychoeducation for the older client and involve the client in treatment planning and progress evaluation. Very little research has specifically focused on treating depression and psychiatric comorbidity simultaneously, so additional research in this area is needed.