Reynolds C F, Kupfer D J
Department of Psychiatry at the University of Pittsburgh School of Medicine, Pennsylvania, USA.
Psychiatr Serv. 1999 Sep;50(9):1167-72. doi: 10.1176/ps.50.9.1167.
Geriatric depression is widespread, affecting at least one of six patients treated in general medical practice and an even higher percentage in hospitals and nursing homes. Depression in later life has serious consequences, including patients' and caregivers' distress, amplification of disability associated with medical and cognitive disorders of later life, increased health care costs, and increased mortality related to suicide and medical illness. Despite the numerous pathways to late-life depression, as well as the complex medical and psychosocial context in which it occurs, it can be effectively diagnosed and treated. To meet the public health challenges posed by geriatric depression over the next 15 years, the major priorities for research and clinical practice must include improvement in recognizing and treating depression among elderly patients seen in the general medical sector, suicide prevention among elderly patients seen in primary care, and acceleration of response to antidepressants. Other major priorities include improving the early recognition of treatment resistance in late-life depression and developing strategies for improving the treatment response of such patients; finding maintenance treatments with long-term efficacy, especially for patients over age 70 and those who have required electroconvulsive therapy; and developing preventive strategies to reduce the liability to late-onset depression.
老年抑郁症很普遍，在普通医疗实践中接受治疗的患者中，至少六分之一受到影响，在医院和养老院中的比例更高。晚年抑郁症会产生严重后果，包括患者和照料者的痛苦、与晚年医学和认知障碍相关的残疾加剧、医疗保健成本增加以及与自杀和疾病相关的死亡率上升。尽管导致晚年抑郁症的途径众多，且其发生的医学和社会心理背景复杂，但它可以得到有效诊断和治疗。为应对未来15年老年抑郁症带来的公共卫生挑战，研究和临床实践的主要优先事项必须包括改善在普通医疗部门就诊的老年患者中抑郁症的识别和治疗、预防初级保健中所见老年患者的自杀以及加快对抗抑郁药的反应。其他主要优先事项包括改善对晚年抑郁症治疗抵抗的早期识别并制定改善此类患者治疗反应的策略；找到具有长期疗效的维持治疗方法，特别是对于70岁以上的患者和那些需要接受电休克治疗的患者；以及制定预防策略以降低迟发性抑郁症的易感性。
