Antidepressants in geriatric depression: what difference have they made?

This article reviews the evidence that antidepressants have improved the prognosis of geriatric depression. It examines studies carried out in the acute, continuation, and maintenance stages of treatment. Naturalistic studies carried out after the introduction of electroconvulsive therapy indicate that about one quarter of patients with major depression in later life remain symptom-free, approximately one third experience at least one relapse but with further recovery, and the remainder have residual symptoms. In about 10% of all cases, depressive symptoms remain severe and intractable. These proportions appear to have altered little since tricyclic antidepressants became available, although recent research into drug prophylaxis suggests that better outcomes may be possible. The article reviews some of the methodological problems that research workers must address. The role of newer antidepressants in prognosis is also discussed.