Clinical management of the depressed geriatric patient: current therapeutic options

Depression is probably the most common psychiatric illness affecting the elderly. Although depression in the elderly usually responds to treatment, it often goes unrecognized and, left untreated, may lead to considerable morbidity and mortality. Reversible causes of depression (e.g., medications; infectious states; endocrine, collagen, neurologic, and neoplastic disorders; and nutritional deficiencies) must all be ruled out before instituting therapy. Psychotherapy, electroconvulsive therapy (ECT), and pharmacologic therapy are the main therapeutic approaches used to manage depression. The pharmacologic options--tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, aminoketones, and triazolopyridines--each appear to be efficacious; however, the side-effect profile of some of the agents makes them more appropriate for use in elderly patients. It is imperative for clinicians, when choosing therapy for elderly depressed patients, to keep firmly in mind all risks, as well as benefits, inherent in each choice.