General management of depression in late life

To summarise, depression in the elderly is often a relapsing, serious illness in which physical treatments by drugs and ECT are the only specific anti-depressant measures we have. Once depressed, patients are likely to suffer further adverse events and are at risk of losing their close emotional supports as a result of the depression itself. The evidence suggests that it is unlikely that a pre-existing close intimate relationship can protect against relapse in the face of further adversity and furthermore it is unlikely that professional social support, as provided by day hospitals and outpatient clinics, is an effective antidote to the adverse effects of continuing problematic social circumstances. We need to learn a great deal more about how to manipulate the social milieu effectively and how to help distressed family carers cope better with the stress of a depressed elderly relative. Admission to an old people's home is rarely the right answer. Finally, let us look more objectively at the ward treatment offered to our seriously depressed patients and not impose a 'therapeutic' regime which is inflexible to individual patient's needs.