Depression in Older Patients

Kiran Rabheru

Major depressive disorder is frequently undiagnosed and untreated in older patients, and can be associated with high morbidity and mortality in this patient group, who are particularly prone to completed suicide or self-neglect. Grief, pain, sleep issues, concurrent medications, altered physiology, and the presence of comorbid medical and psychiatric conditions can complicate the management of depression in older patients. Comorbid medical conditions, including cardiovascular events, stroke, vascular dementia, and Alzheimer's disease, which are common among older patients, can have a significant impact on depression, and vice versa.

Depression is not a natural part of the aging process, and it should be diagnosed and actively treated in the elderly, just as it is in younger patients. Pharmacother-apy can be safe and effective in this population, as long as pharmacokinetic and pharmacodynamic properties, as well as the inherent biological differences in the elderly population are considered when selecting treatments. Psychosocial therapies and antidepressants such as selective serotonin reuptake inhibitors (SSRIs), venla-faxine, and mirtazapine have demonstrated beneficial effects in this population. Although tricyclic antidepres-sants also have demonstrated efficacy, tolerability can be a problem.

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