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This article discusses the prevalent problem of underdiagnosing mental depression in the aged. The authors, arguing depression in the elderly is common but underdiagnosed, offer a list of important symptoms, such as a preoccupation with death, and maintain treatment must be continuous since geriatric depression is a chronic and relapsing illness.

Objective: Anxiety disorders are common in adults with depressive disorders, but several studies have suggested a relatively tow prevalence of anxiety disorders in older individuals with depression. This cross-sectional study measured current and lifetime rates and associated clinical features of anxiety disorders in depressed elderly patients. Method: History of anxiety disorders was assessed by using a structured diagnostic instrument in 182 depressed subjects aged 60 and older seen in primary care and psychiatric settings. Associations between comorbid anxiety disorders and baseline characteristics were measured. The modified structured instrument allowed detection of symptoms that met inclusion criteria for generalized anxiety disorder in a depressive episode. Results: Thirty-five percent of older subjects with depressive disorders had at least one lifetime anxiety disorder diagnosis, and 23% had a current diagnosis. The most common current comorbid anxiety disorders were panic disorder (9.3%), specific phobias (8.8%), and social phobia (6.6%). Symptoms that met inclusion criteria for generlized anxiety disorder, measured separately, were present in 27.5% of depressed subjects. Presence of a comorbid anxiety disorder was associated with poorer social function and a higher level of somatic symptoms. Symptoms of generalized anxiety disorder were associated with a higher level of suicidality. Conclusions: Contrary to previous reports, the present study found a relatively high rate of current and lifetime anxiety disorders in elderly depressed individuals. Comorbid anxiety disorders and symptoms of generalized anxiety disorder were associated with a more severe presentation of depressive illness in elderly subjects.

Objective: This study was conducted to identify which elderly patients with remitted recurrent major depression remain well with maintenance interpersonal psychotherapy after discontinuation of active antidepressant medication (nortriptyline). Method: The authors examined outcomes of maintenance therapy over I year for 47 elderly patients who were randomly assigned to monthly maintenance interpersonal psychotherapy with placebo (N=19) or to placebo and a supportive medication clinic without interpersonal psychotherapy (N=28). A Kaplan-Meier survival analysis was performed on the basis of treatment assignment and subjective sleep quality assessed by the Pittsburgh Sleep Quality Index, on which good subjective sleep quality is indicated by a score of 5 or lower. Results: Nine (90%) of 10 patients reporting good subjective sleep quality (by 1 month into continuation treatment) remained well for at least i year when treated with monthly maintenance interpersonal psychotherapy, versus five (31%) of 16 patients with good sleep quality assigned to a medication clinic, three (33%) of nine patients with impaired sleep quality treated with maintenance interpersonal psychotherapy, and two (17%) of 12 patients with impaired sleep quality assigned to a medication clinic. Conclusions: Recovery of good subjective sleep quality by early continuation treatment is useful in identifying which remitted elderly depressed patients will remain well with monthly maintenance interpersonal psychotherapy, following discontinuation of antidepressant medication, and which patients may be more vulnerable to recurrence of major depressive episodes in the absence of antidepressant medication.

Objective: The authors documented outcomes of elderly depressed patients requiring adjunctive medication during acute-phase pharmacotherapy because of slow or partial response to nortriptyline. Twenty-eight patients (17.7%) received inpatient care at some point during acute-phase treatment. Method: Rates of response, relapse, and sustained remission were examined in 158 elderly patients with recurrent major depression, grouped by whether they received brief treatment with adjunctive medication (lithium, perphenazine, or paroxetine) (N=39) or did not (N=119). Results: The group receiving adjunctive medication had a lower rate of response to acute therapy (64.1% versus 83.2%), a higher relapse rate during continuation therapy (52.0% versus 6.1%), and a lower rate of sustained remission (recovery) (48.7% versus 76.5%) than did the group without augmentation. Conclusions: Elderly depressed patients requiring augmented pharmacotherapy to achieve remission may need continuation of adjunctive medication to remain well and to avoid early relapse. Alternatively, factors that lead to augmentation in the first place (e.g., heightened anxiety) may also increase the risk of relapse.

Depression often goes unrecognized and untreated in older adults, in part because of its atypical presentation and the comorbid medical conditions in this population. Depression may coexist with dementia and is more often seen in patients with certain medical illnesses. Drug therapy is effective in treating depression in 65 to 75% of older patients. Selective serotonin reuptake inhibitors (SSRIs) are often used in this population because of their proven efficacy, safety, and tolerability. The most common side effects of SSRIs are GI disturbances and headaches, which may be minimized by slow dose escalation. Compared with younger adults, the elderly generally require smaller doses but show a similar time course of response to antidepressant therapy., Within the past 5 years, private and federally-funded researchers have put a new face on the picture of clinical depression in older Americans. We've learned much about the wide-ranging scope [...]

Recognizing depressive symptoms at their onset is the key to the treatment of depression among geriatric patients. Important clues that physicians should establish in their diagnosis are depressed mood, anxiety and agitation, feelings of pessimism and hopelessness, weight loss or weight gain, fatigue and changes in sleep pattern. Sensitive interviewing, with the physician asking questions as to symptoms without telling them that they have a problem, is an effective technique to uncover depression. Talking to family members and friends also gives a clue in establishing these symptoms., Major or minor depression is estimated to affect 5 to 10% of the elderly population in the community, and up to 25% of elderly residents in long-term care facilities.[1] Unrecognized [...]

Objective: This study sought to determine whether a set of symptoms interpreted as complicated grief could be identified and distinguished from bereavement-related depression and whether the presence of complicated grief would predict enduring functional impairments. Method: Data were derived from a study group of 82 recently widowed elderly individuals recruited for an investigation of physiological changes in bereaved persons. Baseline data were collected 3-6 months after the deaths of the subjects' spouses, and follow-up data were collected from 56 of the subjects 18 months after the baseline assessments. Candidate items for assessing complicated grief came from a variety of scales used to evaluate emotional functioning (e.g., the Hamilton Depression Rating Scale, the Brief Symptom Inventory). The outcome variables measured were global functioning, medical illness burden, sleep, mood, self-esteem, and anxiety. Results: A principal-components analysis conducted on intake data (N=82) revealed a complicated grief factor and a bereavement-depression factor. Seven symptoms constituted complicated grief: searching, yearning, preoccupation with thoughts of the deceased, crying, disbelief regarding the death, feeling stunned by the death, and lack of acceptance of the death. Baseline complicated grief scores were significantly associated with impairments in global functioning, mood, sleep, and self-esteem in the 56 subjects available for follow-up. Conclusions: The symptoms of complicated grief may be distinct from depressive symptoms and appear to be associated with enduring functional impairments. The symptoms of complicated grief, therefore, appear to define a unique disorder deserving of specialized treatment.

Objective: This study examined the effects of maintenance treatment for late-life depression on social adjustment. The authors hypothesized that elderly patients recovering from depression would have better social adjustment with medication and interpersonal psychotherapy than with medication or psychotherapy alone. Method: Patients aged 60 and older recovering from recurrent major depression were randomly assigned to one of four treatments: nortriptyline and interpersonal psychotherapy, nortriptyline and clinic visits, placebo and psychotherapy, or placebo and clinic visits. The Social Adjustment Scale was administered every 3 months until illness recurrence. Combined treatment was compared to monotherapy on scores over 1 year among patients who remained in recovery (N=49). Results: Patients receiving nortriptyline and interpersonal psychotherapy maintained social adjustment, which declined in those receiving monotherapy. Conclusions: Treatment of late-life depression with nortriptyline and psychotherapy is more likely to maintain social adjustment than treatment with either alone. Combination therapy improves not only duration but quality of wellness.

Objective: Depression has been associated with increased platelet activation. Variations in the serotonin-transporter-linked promoter region (5-HTTLPR) polymorphism may influence the degree of activation. The authors examined the association among depression, platelet activation, and 5-HTTLPR genotype. Method: Elderly subjects with (N=61) and without (N=12) major depression were assessed for cognitive impairment, cardiovascular disease, and two indices of platelet activation. The depressed subjects were genotyped for the 5-HTTLPR polymorphism. Results: The depressed subjects were older, were more cognitively impaired, and had higher platelet factor 4 and [beta]-thromboglobulin levels; cardiovascular disease was minimal in both groups. In the depressed group, subjects with the 5-HTTLPR I/I genotype had significantly higher platelet factor 4 and [beta]-thromboglobulin levels. Conclusions: Platelet activation is increased in elderly depressed patients, especially those with the 5-HTTLPR I/I genotype. This finding suggests how genetic differences may influence cardiovascular mortality in depressed patients with ischemic heart disease. (Am J Psychiatry 2001; 158:2074-2076)

Depression is a common illness among the elderly. Studies showed that approximately 15% of the population over the age of 65 exhibit the symptoms of depression, with a prevalence of 5%-10% in patients attending primary care clinics and 15%-25% among elders residing in long-term care facilities. The problem, which is expected to grow with the rise in the aged population, has been pointed as the primary cause of disabilities among the aged. Effective methods for recognizing and treating depression in the elderly are needed to avoid these disabilities., Demographic shifts are taking place rapidly in the United States and are resulting in the graying of America. Occurring within the growing geriatric segment of the population is a relatively [...]