Diagnosis and treatment of depression in late life: the NIH Consensus Development Conference Statement

The National Institutes of Health Consensus Development Conference on Diagnosis and Treatment of Depression in Late Life brought together biomedical and behavioral scientists, surgeons, and other health care professionals as well as the public to address the epidemiology, pathogenesis, pathophysiology, prevention, and treatment of depression in the elderly and to alert both the professional and lay public to the seriousness of depression in late life, to its manifestations and useful treatments, and to areas needing further study. Following 1 1/2 days of scientific presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) depression in late life occurs in the context of numerous social and physical problems that often obscure or complicate diagnosis and impede management of the illness; (2) because there is no specific diagnostic test for depression, an attentive and focused clinical assessment is essential for diagnosis; (3) depressed elderly people should be treated vigorously with sufficient doses of antidepressants and for a sufficient length of time to maximize the likelihood of recovery; (4) electroconvulsive therapy and psychosocial treatments also can be effective in the treatment of elderly depressed patients; and (5) estimates of the prevalence of depression vary widely, but the highest rates are in nursing homes and other residential settings, and staff in many of these facilities are not equipped to recognize or treat depressed patients. The full text of the consensus panel's statement follows.