Depression: making the diagnosis and using SSRIs in the older patient

Depression often goes unrecognized and untreated in older adults, in part because of its atypical presentation and the comorbid medical conditions in this population. Depression may coexist with dementia and is more often seen in patients with certain medical illnesses. Drug therapy is effective in treating depression in 65 to 75% of older patients. Selective serotonin reuptake inhibitors (SSRIs) are often used in this population because of their proven efficacy, safety, and tolerability. The most common side effects of SSRIs are GI disturbances and headaches, which may be minimized by slow dose escalation. Compared with younger adults, the elderly generally require smaller doses but show a similar time course of response to anti-depressant therapy.