Depression and aging: a look to the future.

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.