Depression is prevalent in the elderly and associated with increased morbidity and mortality. Diagnosis can be complicated by the presence of concomitant medical and/or psychiatric disorders, and it is important to exclude a number of factors, such as neurological disease, hormonal causes, chronic illness, or substance abuse, particularly alcohol. Although comorbid medical illness may contribute to depressive illness, depressive disorders are not a consequence of aging. Most classes of antidepressants that are effective in adult patients are effective in the elderly and, in general, they have shown comparable efficacy in terms of response rates. However, antidepressants vary in terms of their tolerability profiles, and treatment of the elderly is complicated by their sensitivity to medication side effects and the potential for serious adverse events, such as falling or delirium. A correct dosing strategy is particularly important for the elderly, whose treatment should usually start at low doses of antidepressants and increase slowly. It is possible to successfully treat elderly patients with depressive disorder, and antidepressant therapy should be selected on the basis of prior response to treatment, the adverse-event profile, and the potential for drug-drug interactions. Treatment should also take into account the likelihood of achieving and maintaining remission of symptoms in order to restore the patient to a baseline level of functioning appropriate for their age.
