Recognition and treatment of depression in the elderly

The author reviews clinical issues related to recognition of depression in elderly patients and provides a practical, systematic approach to diagnostic and treatment decision making. Factors complicating accurate diagnosis of geriatric depression include the presence of medical illness, dementia syndromes, cohort effects, ageism, and heterogeneity of patient populations. Age-related pharmacokinetic changes and polypharmacy need to be considered because they will increase an elderly person's sensitivity to medications. A variety of antidepressant drugs has been found to be safe and effective in elderly depressed patients, but some modification in their use is suggested. A systematic approach is provided to assist the clinician when confronted with this often complex and challenging patient population.