treatment of depression in the elderly: a systematic review

Depression is a common symptom and a major public health problem in the elderly. Despite its prevalence and seriousness, depressive disorder in older people remains under-treated. The optimal treatment of depression in later life is crucial, and requires appreciation of several age-related factors such as comorbidity, polypharmacy, altered drug kinetics, variable treatment response and increased predisposition to side effects. Although sometimes difficult to diagnose because of concurrent stressors medical illness, or dementia, depression in elderly patients responds readily to appropriate therapy. When untreated, this disorder may result in increased morbidity and mortality or suicide. Effective therapeutic options for late-life depression, as in younger patients, include psychotherapy and pharmacotherapy. Because of their favorable adverse effect profiles and safety in cases of overdose, the selective serotonin reuptake inhibitors have, in most cases, replaced tricyclic antidepressants as first-line therapy when antidepressants are indicated. SSRIs considered to have the best safety profile in the elderly are citalopram, escitalopram, and sertraline. Finally, electroconvulsive therapy offers a safe and effective alternative for patients refractory to or unable to tolerate antidepressant medication.