Late-life delusional depression: acute and long-term treatment.

Treatment studies of delusional major depression demonstrate a poor response to standard antidepressant medications. Longitudinal studies demonstrate high relapse rates, even in patients receiving postdischarge antidepressants. The poor medical and psychiatric outcomes for late-life delusional depression and the increased risk for adverse medication reactions in this population underscore the importance of developing effective postrecovery treatments. Studies of mixed-age adults demonstrate the effectiveness of acute treatment with either electroconvulsive therapy or combination pharmacotherapy with high doses of neuroleptics and antidepressants. In considering these results in relation to the treatment of late-life delusional depression, attention must be given to the particular vulnerabilities to medication side effects of elderly patients. The potential effectiveness of continuation treatment with combined antidepressant-neuroleptic therapy is discussed. Clinical and methodologic issues related to studying the effectiveness of combination treatment in elderly patients are emphasized.