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MENTAL HEALTH
CHALLENGES

Geriatric

Depression

and Its

Treatment

By Frederick Brown, MD

INTRODUCTION
My most important message is, “depression is not a normal part ment recommendations, increased need for home nursing and ad-
of aging.” All of us have had days when we feel “down” or “de- mission to long-term care facilities. The pharmacological treatment
pressed.” Having this feeling/mood of “depression” is not the same is fairly similar to that of depressive illness in younger patients, al-
as “depressive illness.” Depressive illness deserves treatment, though non-medical approaches assume more importance.
whether found in a child, adolescent, adult or older person. Since
this article deals with geriatric depression, “geriatric” should be de- EPIDEMIOLOGY
fined. There was a time for me when “geriatric” referred to that Prevalence and incidence percentages reflect the criteria for di-
slow-moving, gray-haired grumpy person in the reception area. agnosis and the setting/context of the survey. In community set-
Now that I am gray-haired, older and slower moving, I had to tings, the percent of individuals with onset of new depressive illness
reevaluate what “geriatric” means. Late onset depression (LOD) or (incidence) in late life is relatively low, between 1 – 2.5% (for major
late life depression (LLD) means depressive illness with first ap- depressive disorder, with another 1 – 3% having less severe depres-
pearance at ages 60 to 65, although that age is somewhat arbitrary; sive conditions.) These less severe depressive conditions can still
as one can find white matter changes (markers of aging) in patients cause significant impairment, are associated with higher health costs,
only 55 years old who are depressed. In general, LLD has a worse and usually should be treated. Often however, there is not a formal
prognosis then early onset depression, probably because of the in- diagnosis made nor treatment offered for many individuals with de-
flammatory, vascular, and neurodegenerative processes which have pressive illness surveyed in the community.
been occurring for 60 years or so. Nonetheless, accurate diagnosis The prevalence depends on the population being studied. In gen-
and treatment is beneficial to the patient, appreciated by the family eral, as in a younger population, approximately 10% of men and
and gratifying to the physician. There are some factors which make 15% of women have late life depression. In a community popula-
the diagnoses of LOD or LLD harder to make in geriatric patients. tion the prevalence varies from 14 – 20%. Among hospitalized pa-
These patients should be treated because it will decrease serious tients the prevalence is 12 – 45% and may be as high as 40% in
consequences such as suicide, poor compliance with medical treat- long-term care facilities.
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