Geriatric depression: avoiding the pitfalls of primary care.

: Depression in the elderly should be viewed as a biological disorder, with multifactorial etiology, and not as a consequence of increasing social, physical, and material losses. Diagnosis is made basically on somatic symptoms, the most important ones being chronic fatigue, chronic pain, chronic sleep disorder, chronic gastrointestinal disturbance, and dysphoria. Other illnesses that might be present instead of or in addition to depression should be sought, both before depression therapy is started and also in the face of persistent symptoms after treatment is started. Basic treatment is with antidepressant medications, with careful attention to selection of drug and dosage, and careful monitoring for adverse effects. Antidepressant therapy and any other applicable forms of therapy are not mutually exclusive, and any other means of improving the patient's overall situation should be vigorously sought.