Treatment of depression in elderly patients: recent advances.

Although sometimes difficult to diagnose because of concurrent stressors, medical illness, or dementia, depression in elderly patients responds readily to appropriate therapy. When untreated, this disorder may result in increased morbidity and mortality or suicide. Effective therapeutic options for late-life depression, as in younger patients, include psychotherapy and pharmacotherapy. Short-term, highly focused forms of psychotherapy are helpful for elderly patients who are reluctant or unable to tolerate antidepressant medication. Because of their favorable adverse effect profiles and safety in cases of overdose, the selective serotonin reuptake inhibitors have, in most cases, replaced tricyclic antidepressants as first-line therapy when antidepressants are indicated. Psychostimulants may be helpful for medically ill elderly patients with depressive symptoms. Finally, electroconvulsive therapy offers a safe and effective alternative for patients refractory to or unable to tolerate antidepressant medication.