Treatment of depression in the elderly. General clinical considerations.

Epidemiological investigations indicate that there is a high incidence of affective disorders in the elderly. Women predominate over men which may be due to diagnostic problems. It is a general assumption that socio- and psychogenic factors, somatic illness and treatment with drugs have etiological importance for affective disorders in the elderly. This assumption needs further investigation, however. Post mortem investigations have shown that there are biochemical changes in the brain in the elderly and in dementia disorders, indicating that there is a reduced activity in the serotoninergic and cholinergic systems. These biochemical changes may increase vulnerability to affective disorders in the elderly and in demented patients. When discussing the cause of the high incidence of affective disorders among the elderly a chain of factors must be considered. Psychogenic and sociogenic factors may precipitate the disease but biochemical disturbances related to the ageing process may make the individual vulnerable to affective disorders. Theoretically zimelidine seems to be the drug of choice when treating affective disorders in the elderly.