Treatment of geriatric depression

The author reviews clinical issues regarding the treatment of late-life depression. Accurate diagnosis is complicated by the presence of medical illness, dementia syndromes, and heterogeneity of patient populations. Older depressed patients are often sensitive to drug toxicity resulting from age-related pharmacokinetic changes and polypharmacy. Thus, modification in the use of antidepressant drugs is needed to avoid side effects. Numerous antidepressant drugs are safe and efficacious in elderly depressed patients, and newer agents such as the selective serotonin reuptake inhibitors are often preferred over tricyclic antidepressants because of side effect profiles. Nonpharmacological approaches, alone and in combination with antidepressant drugs, are also useful, and maintenance treatments appear to reduce the likelihood of relapse.