Depression in Late Life: Current Issues

Depression is one of the leading causes of suffering in the elderly, but it is often under-diagnosed and under-treated. Depression in late life represents a heterogeneous group of mood disturbances that may present with variable features. Current issues in depression in late life are discussed. The prevalence of ”clinically significant depressive symptoms” among community-dwelling older adults ranges from approximately 8% to 16%. The prevalence estimates of ”major depression” in community samples of elderly people have been quite low, ranging from 1% to 4%. There is increasing evidence that structural change, especially vascular in nature, renders some people in later life vulnerable to depression. Data regarding longitudinal outcomes and biological, psychosocial, and functional correlates increasingly support the notion that minor and subsyndromal depressions are part of a spectrum of depressive illness severity. Disorders of the basal ganglia and their prefrontal projections are often complicated by depression and result in executive dysfunction. These depressed patients with executive dysfunction appear at a higher risk of developing dementia later In later life, the most common diagnosis in those who attempt or complete suicide is major depression. Comorbidity with an anxiety disorder is associated with a more severe depression, a higher level of suicidality and poorer treatment outcomes. Increased medical comorbidity is characteristic in late-life depression. In spite of similar treatment responses, elderly patients spend longer time to remission, and have higher rate of relapse than do younger patients. By raising awareness and understanding of depression among primary healthcare, more depressed elderly with comorbid medical problems can be successfully identified and helped.