[Late-life depression--clinical features, treatment and prognosis]

A generation ago, geriatric depression was regarded either as a natural reaction to the privations and multiple losses that accompany old age, or as an irreversible consequence of cerebral degeneration heralding dementia. Even if physicians overcame their expectation of the inevitability of depression in old age, an unhealthy nihilism concerning the effects of antidepressant treatment in this group held sway. Elderly depressed patients, probably more than any other group, have been helped by the remarkable advances in biological treatments for depression. Those of us too young to remember the advent of electroconvulsive therapy in the 1930s and the introduction of the tricyclics and monoamine oxidase inhibitors in the 1960s can only dimly imagine the extraordinary impact that such advances must have had on psychiatric practice. In the hands of experienced clinicians, these treatments offered safe and efficacious relief of depression. Introduction of the selective serotonin reuptake inhibitors in the 1980s was particularly welcome to geriatric psychiatrists. Although those drugs are probably no more effective than the tricyclics, they are significantly more benign with regard to side effects and to the consequences of overdose. This is an obviously important point in the treatment of elderly patients, who are so often exquisitely sensitive to the hypotensive, cardiotoxic, and central and peripheral anticholinergic effects of the tricyclics.