Methodology of Treatment Studies in Geriatric Depression

Treatment studies of geriatric depression should focus not only on recovery and remission but also on relapse, recurrence, disability, quality of life, cognitive impairment, and exacerbation of medical morbidity. Each of these outcomes appears to have different predictors. Medical burden may influence geriatric depression, response to antidepressants, and overall disability, as well as specific conditions underlying geriatric depression (e.g., Alzheimer's disease, stroke, or parkinsonism). Measures of medical morbidity, cognitive impairment, and perhaps structural brain abnormalities should be considered as possible influences on treatment response. Studies of geriatric depression associated with specific disease entities are necessary, using instruments that avoid rating symptoms and signs that are part of a concurrent dementia syndrome or result from a medical illness. However, there should also be ratings with an "all-inclusive" approach that disregards the origin of depressive symptoms-whether from depression, dementia, or the medical illness. This strategy will reduce the risk of underdiagnosing depression.