Advances in pharmacotherapy: depression in the elderly--issues and advances in treatment

Depression continues to be major cause of morbidity and mortality in the elderly. It is estimated that 1-5% of elderly persons who live in the community and 5-43% of nursing-home patients have major depression. Symptoms of depression in the elderly do not differ substantially from younger patients. Tricyclic antidepressants continue to be the drugs of choice in the elderly because of their long record of use with proven efficacy, known adverse effect profile and availability of less expensive generic formulations. The newer second-generation antidepressants, including serotonin reuptake inhibitors, appear to offer a major advantage of fewer serious adverse effects in the elderly. This review will highlight recent developments regarding the prevalence and treatment of depression in the elderly.