Treating depression in old age: is it worth the effort?

Physical changes which accompany aging and the presence of concurrent medical problems often complicate the treatment of depression in old age. When physicians treat patients who have a long list of problems and medications they can become overly worried about the potential risks of treatment and deny the patient a chance at recovery. Clinicians should, however, remember that treatment response is generally good for elderly persons who have major depressive episodes while spontaneous remissions are less likely to occur. The risks of treatment can be minimized by careful evaluation of the patient's problems, choosing medications which have a low side effect profile, starting at a low dose and closely monitoring for side effects. The risks of leaving the depression untreated are usually greater than the potential risks of treatment. The consensus among clinicians interested in the care of elderly depressives is that treatment efforts are usually rewarded by improved quality of life and good remission of depressive symptoms. We need, however, to continue to look for rapidly efficacious treatments with fewer side effects.