The treatment of depression in elderly patients

Primary care physicians provide a large proportion of psychiatric care today, especially for elderly persons with limited resources and concomitant medical diseases. To determine the frequency and type of psychiatric care provided by internists, the experience of a large academic group practice was studied. Depression was the most frequent psychiatric diagnosis among persons over 59 years of age and the fifth most common of all diagnoses made by physicians. Consultations with psychiatrists were infrequent and were used primarily for confirmation of the diagnosis. Physicians generally treated the depression with supportive counseling and often employed pharmacologic therapy with tricyclic antidepressants. Elderly patients were less likely than younger patients to receive tricyclic antidepressants, and they received lower doses. The observed response to antidepressant drugs was positive but required at least 50 mg to be taken daily. Side effects were frequent, especially at doses greater than 100 mg/d, but generally not severe.