Assessment and management of major depressive disorder in older adults

Major depression disorder (MDD) is one of the most common mental disorders world-wide and is prevalent throughout the lifespan, with prevalence estimates of 1-5% in those 65 years of age and older.

The aim of this mini-review is to briefly summarize clinically relevant topics within the domain of later-life MDD.

The mini-review presents an overview of epidemiology, complications of late life MDD, risk factors and clinical presentation, clinical assessment, general issues relevant to the treatment of the older adult with MDD, drug treatments, discussion of how medical complexity affects drug treatment and other treatment modalities.

The mini-review concludes with a short discussion of clinical and research implications. Treatment of depression in the geriatric population is a complex endeavor and clinicians often are faced with medical, social, and environmental issues which can impede the treatment process. Antidepressant drugs, particularly the SSRI and SNRI antidepressants are helpful, but dosing titration needs to be considered against the backdrop of comorbidity and concomitant medications. Psychotherapy and other approaches are additional avenues to consider in the older individuals with MDD. Future research in particular needs to address older people with more extensive medical complexity as well as the "oldest-old", individuals in their 80's and beyond.