Depression in the elderly: A review and update

Depression is a major source of suffering and disability among the elderly. It may be overlooked among elders because of its co-occurrence with the aging process, grief, dementia, and medical illness. The author reviewed the field in 1994, and in this paper describes important developments of the past two decades. These include evolving concepts in diagnosis such as minor depression, vascular depression, and the depression of Alzheimer's disease. Complex inter-relationships among depression and medical diseases have been explored, especially cardiovascular and cerebrovascular disease. During this period selective serotonin reuptake inhibitors and serotonin/norepinephrine reuptake inhibitors have largely replaced tricyclic antidepressants and monoamine oxidase inhibitors, while electroconvulsive therapy has continued to be utilized. Repetitive transcranial stimulation is in its infancy and its role in geriatric depression is being defined. Developments in psychotherapy have solidified its place in the treatment of geriatric depression, particularly cognitive behavioral therapy.