CNS Drugs

, Volume 9, Issue 1, pp 17–30 | Cite as

Diagnosis and Treatment of Geriatric Depression

  • Robert Lasser
  • Erika Siegel
  • Ruth Dukoff
  • Trey Sunderland
Disease Management


Geriatric depression is a common psychiatric illness affecting as many as one-third of the older population. With the growing number of elderly in many countries of the world, the morbidity and mortality associated with untreated and partially treated depression is of great concern from both a medical and economic perspective.

Depression in the elderly often presents with more somatic or anxious features and less of the subjective sadness expressed by younger groups. In addition, in the elderly, depressive-spectrum disorders (which include minor depression, dysthymia, mixed anxiety/depression, bereavement-related depression and even suicidal ideation) are generally under-recognised and undertreated by health professionals.

The clinical mismatch between high prevalence but undertreatment stems from patient and physician attitudes toward depression as a ‘normal’ response to aging and loss, diagnostically confusing medical illness-related symptomatology, and noncompliance with prescribed treatment. Furthermore, late-onset depression may hold special prognostic value in the elderly, with the relationship between late-onset depression and cerebrovascular events and progressive dementing illness being particularly strong.

Therapeutically, there has been a recent expansion in the pharmacological tools that can be used to treat depression. A variety of new agents are now available that have adverse effect, pharmacodynamic and target-receptor profiles that differ from the older agents. For example, newer drugs that block the serotonin (5-hydroxytryptamine; 5-HT) transporter have supplanted older agents that cause more frequent and toxic adverse effects. These newer agents have also focused attention on the impact of polypharmacy on the hepatic cytochrome P450 system, which is responsible for drug metabolism and elimination. Electroconvulsive therapy and psychotherapy remain effective nonpharmacological treatments for geriatric depression.

Generally, the opportunities for therapeutic intervention in geriatric depression suggest that greater diagnostic attention and more widespread application of treatments for this increasingly prevalent disorder continue to be needed.


Adis International Limited Paroxetine Mirtazapine Clin Psychiatry Moclobemide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    United Nations Statistical Office. Demographic yearbook. New York: Department of Economic and Social Affairs, United Nations, 1993: 142–53Google Scholar
  2. 2.
    United States, Bureau of the Census. Statistical abstract of the United States. 115th ed. Washington, DC: US Department of Commerce, 1995: 88–9Google Scholar
  3. 3.
    Bland RC, Newman SC, Orn H. Period prevalence of psychiatric disorders in Edmonton. Acta Psychiatr Scand 1988; 77: 43–9CrossRefGoogle Scholar
  4. 4.
    Robins LN, Regier DA. Psychiatric disorders in America: the Epidemiological Catchment Area study. New York: The Free Press, MacMillan Inc, 1991Google Scholar
  5. 5.
    Henderson AS, Jorm AF, Mackinnon A, et al. The prevalence of depressive disorders and the distribution of depressive symptoms in later life: a survey using Draft ICD-10 and DSM-III-R. Psychol Med 1993; 23(3): 719–29PubMedCrossRefGoogle Scholar
  6. 6.
    Slater SL, Katz IR. Prevalence of depression in the aged: formal calculations versus clinical facts. J Am Geriatr Soc 1995; 43: 78–9PubMedGoogle Scholar
  7. 7.
    Rovner BW, German PS, Brant LJ, et al. Depression and mortality in nursing homes. JAMA 1991 Feb 27; 265(8): 993–6PubMedCrossRefGoogle Scholar
  8. 8.
    Parmelee PA, Katz IR, Lawton MR. Incidence of depression long-term care settings. J Gerontol 1992; 47(6): M189–96PubMedGoogle Scholar
  9. 9.
    Blazer D. The epidemiology of depression in late life. J Geriatr Psychiatry 1989; 22: 35–52PubMedGoogle Scholar
  10. 10.
    Ernst C, Angst J. Depression in old age: is there a real decrease in prevalence? A review. Eur Arch Psychiatry Clin Neurosci 1995; 245: 272–87PubMedCrossRefGoogle Scholar
  11. 11.
    Knäuper B, Wittchen HU. Diagnosing major depression in the elderly: evidence for response bias in standardized diagnostic interviews? J Psychiatr Res 1994; 28(2): 147–64PubMedCrossRefGoogle Scholar
  12. 12.
    Martin LM, Fleming KC, Evans JM. Recognition and management of anxiety and depression in elderly patients. Mayo Clin Proc 1995; 70: 999–1006PubMedCrossRefGoogle Scholar
  13. 13.
    Richardson JP, Gallo JJ. Geriatrics for the clinician: treatment of depression in the elderly. Md Med J 1996 Jul; 45(7): 553–6PubMedGoogle Scholar
  14. 14.
    Devanand DP, Nobler MS, Singer T, et al. Is dysthymia a different disorder in the elderly? Am J Psychiatry 1994 Nov; 151(11): 1592–9PubMedGoogle Scholar
  15. 15.
    Kennedy GJ. The geriatric syndrome of late-life depression. Psychiatr Serv 1995 Jan; 46(1): 43–8PubMedGoogle Scholar
  16. 16.
    Lebowitz BD, Martinez RA, Niederehe G, et al. Treatment of depression in late life: NIMH/MacArthur Foundation Workshop report. Psychopharmacol Bull 1995; 31(1): 185–202PubMedGoogle Scholar
  17. 17.
    Tannock C, Katona C. Minor depression in the aged. Drugs Aging 1995; 6(4): 278–92PubMedCrossRefGoogle Scholar
  18. 18.
    Blazer D, Hughes DC, George LK. The epidemiology of depression in an elderly community sample. Gerontologist 1987; 27: 281–7PubMedCrossRefGoogle Scholar
  19. 19.
    Katz IR, Lesher E, Kleban M, et al. Clinical features of depression in the nursing home. Int Psychogeriatr 1989; 1(1): 5–15PubMedCrossRefGoogle Scholar
  20. 20.
    Howland RH, Thase ME. Biological studies of dysthymia. Biol Psychiatry 1991 Aug 1; 30(3): 283–304PubMedCrossRefGoogle Scholar
  21. 21.
    Hellerstein DJ, Yanowitch P, Rosenthal J, et al. A randomized double-blind study of fluoxetine versus placebo in the treatment of dysthymia. Am J Psychiatry 1993; 150: 1169–75PubMedGoogle Scholar
  22. 22.
    Wells KB, Burnam MA, Rogers W, et al. The course of depression in adult outpatients: results from the medical outcomes study. Arch Gen Psychiatry 1992 Oct; 49: 788–94PubMedCrossRefGoogle Scholar
  23. 23.
    Koenig HG, Blazer DG III. Minor depression in late-life. Am J Geriatr Psychiatry 1996; 4Suppl. 1: S14–21Google Scholar
  24. 24.
    Kivelä SL. Long-term prognosis of major depression in old-age: a comparison with prognosis of dysthymic disorder. Int Psychogeriatr 1995; 7: 69–82PubMedCrossRefGoogle Scholar
  25. 25.
    Rothschild AJ. The diagnosis and treatment of late-life depression. J Clin Psychiatry 1996; 57Suppl. 5: 5–11PubMedGoogle Scholar
  26. 26.
    Brodaty H. Think of depression: atypical presentations in the elderly. Aust Fam Physician 1993 Jul; 22(7): 1195–203PubMedGoogle Scholar
  27. 27.
    Bonner D, Howard R. Treatment-resistant depression in the elderly. Int Psychogeriatr 1995; 7: 83–94PubMedCrossRefGoogle Scholar
  28. 28.
    Baron M, Mendlewicz J, Klotz J. Age-of-onset and genetic transmission of affective disorders. Acta Psychiatr Scand 1981; 64: 373–80PubMedCrossRefGoogle Scholar
  29. 29.
    Fava M, Alpert JE, Bonis JS, et al. Patterns of personality disorder comorbidity in early-onset versus late-onset major depression. Am J Psychiatry 1996 Oct; 153(10): 1308–12PubMedGoogle Scholar
  30. 30.
    Ranga Rama Krishnan K, Gadde KM. The pathophysiologic basis for late-life depression. Am J Geriatr Psychiatry 1996; 4Suppl. 1: S22–33Google Scholar
  31. 31.
    Folstein SE, Peyser CE, Starkstein SE, et al. Subcortical triad of Huntington’s disease: a model for a neuropathology of depression, dementia, and dyskinesia. In: Carroll BJ, Barrett JE, editors. Psychopathology and the brain. New York: Raven Press, 1991: 65–75Google Scholar
  32. 32.
    Coffey CE, Figiel GS. Neuropsychiatric significance of subcortical encephalomalacia. In: Carroll BJ, Barrett JE, editors. Psychopathology and the brain. New York: Raven Press, 1992: 243–64Google Scholar
  33. 33.
    Cummings J. Depression and Parkinson’s disease: a review. Am J Psychiatry 1992; 149: 443–54PubMedGoogle Scholar
  34. 34.
    Ranga Rama Krishnan K. Neuroanatomic substrates of depression in the elderly. J Geriatr Psychiatry Neurol 1993 Jan-Mar; 6: 39–58Google Scholar
  35. 35.
    Figiel GS, Rama Ranga Krishnan K, Doraiswamy PM, et al. Subcortical hyperintensities on brain MRI: a comparison between late age onset and early onset elderly depressed subjects. Neurobiol Aging 1991; 26: 245–7CrossRefGoogle Scholar
  36. 36.
    Alexopoulos GS, Young RC, Shindledecker R. Brain computed tomography in geriatric depression and primary degenerative dementia. Biol Psychiatry 1992; 31: 591–9PubMedCrossRefGoogle Scholar
  37. 37.
    Lesser IM, Boone KB, Mehringer CM, et al. Cognition and white matter hyperintensities in older depressed patients. Am J Psychiatry 1996; 153: 1280–7PubMedGoogle Scholar
  38. 38.
    Salloway S, Malloy P, Kohn R, et al. MRI and neuropsychologi-cal differences in early- and late-onset geriatric depression. Neurology 1996 Jun; 46: 1567–74PubMedCrossRefGoogle Scholar
  39. 39.
    Ranga Rama Krishnan K, Turpler LA, Ritchie JC, et al. Apolipoprotein E-e4 frequency in geriatric depression. Biol Psychiatry 1996; 40: 69–71CrossRefGoogle Scholar
  40. 40.
    Reding M, Haycox J, Blass J. Depression in patients referred to a dementia clinic: a three-year prospective study. Arch Neurol 1986; 42: 894–6CrossRefGoogle Scholar
  41. 41.
    Kral VA, Emery OB. Long-term follow-up of depressed pseudodementia of the aged. Can J Psychiatry 1988 Jun; 34(5): 445–6Google Scholar
  42. 42.
    Alexopoulos GS, Meyers BS, Young RC, et al. The course of geriatric depression with ‘reversible dementia’: a controlled study. Am J Psychiatry 1993 Nov; 150(11): 1693–9PubMedGoogle Scholar
  43. 43.
    Alexopoulos GS, Young RC, Meyers BS. Geriatric depression: age of onset and dementia. Biol Psychiatry 1993; 34: 141–5PubMedCrossRefGoogle Scholar
  44. 44.
    Boone KB, Lesser I, Miller B, et al. Cognitive functioning in a mildly to moderately depressed geriatric sample: relationship to chronological age. J Neuropsychiatry 1994 Summer; 6(3): 267–72Google Scholar
  45. 45.
    Wells KB, Stewart A, Hays RD, et al. The functioning and wellbeing of depressed patients: results from the medical outcomes study. JAMA 1989; 262: 914–9PubMedCrossRefGoogle Scholar
  46. 46.
    Caine ED, Lyness JM, Conwell Y. Diagnosis of late-life depression. Am J Geriatr Psychiatry 1996; 4Suppl. 1: S45–50Google Scholar
  47. 47.
    Newhouse P. Use of serotonin selective reuptake inhibitors in geriatric depression. J Clin Psychiatry 1996; 57Suppl. 5: 12–22PubMedGoogle Scholar
  48. 48.
    Conwell Y. Outcomes of depression. Am J Geriatr Psychiatry 1996; 4Suppl. 1: S34–44Google Scholar
  49. 49.
    Rovner BW. Depression and increased risk of mortality in the nursing home patient. Am J Med 1993 May 24; 94Suppl. 5A: 19S–22SPubMedGoogle Scholar
  50. 50.
    Alexopoulos GS, Vrontou C, Kakuma T, et al. Disability in geriatric depression. Am J Psychiatry 1996 Jul; 153(7): 877–85PubMedGoogle Scholar
  51. 51.
    Brodaty H, Harris L, Peters K, et al. Prognosis of depression in the elderly. Br J Psychiatry 1993; 163: 589–96PubMedCrossRefGoogle Scholar
  52. 52.
    Alexopoulos GS, Meyers BS, Young RC, et al. Recovery in geriatric depression. Arch Gen Psychiatry 1996 Apr; 53: 305–12PubMedCrossRefGoogle Scholar
  53. 53.
    Reynolds III CF, Frank E, Kupfer DJ, et al. Treatment outcome in recurrent major depression: a post hoc comparison of elderly (‘young old’) and midlife patients. Am J Psychiatry 1996; 153: 1288–92PubMedGoogle Scholar
  54. 54.
    Farrell KR, Ganzini L. Misdiagnosing delirium as depression in medically ill elderly patients. Arch Intern Med 1995 Dec 11; 155: 2459–64PubMedCrossRefGoogle Scholar
  55. 55.
    Kalchthler T, Coccaro E, Lichtiger S. Incidence of polypharmacy in a long-term care facility. J Am Geriatr Soc 1977; 25: 308–13Google Scholar
  56. 56.
    Everitt DE, Avorn J. Drug prescribing for the elderly. Arch Intern Med 1986; 146: 2393–6PubMedCrossRefGoogle Scholar
  57. 57.
    Katz IR. Drug treatment of depression in the frail elderly: discussion of the NIH consensus development conference on the diagnosis and treatment of depression in late life. Psychopharmacol Bull 1993; 29(1): 101–8PubMedGoogle Scholar
  58. 58.
    Kerremans AL. Cytochrome P450 isoenzymes: importance for the internist. Neth J Med 1996; 48: 237–43PubMedCrossRefGoogle Scholar
  59. 59.
    Nemeroff CB, DeVane CL, Pollock BG. Newer antidepressants and the cytochrome P450 system. Am J Psychiatry 1996 Mar; 153(3): 311–20PubMedGoogle Scholar
  60. 60.
    Ereshefsky L, Riesenman C, Lam YW. Antidepressant drug interactions and the cytochrome P450 system: the role of cytochrome P450 2D6. Clin Pharmacokinet 1995; 29Suppl. 1: 10–9PubMedCrossRefGoogle Scholar
  61. 61.
    Brøsen K. Are pharmacokinetic drug interactions with the SSRIs an issue? Int Clin Psychopharmacol 1996; 11Suppl. 1: 23–7PubMedCrossRefGoogle Scholar
  62. 62.
    Ketter TA, Flockhart DA, Post RM, et al. The emerging role of cytochrome P450 3A in psychopharmacology. J Clin Psychopharmacol 1995; 15: 387–98PubMedCrossRefGoogle Scholar
  63. 63.
    Knegtering H, Eijck M, Huijsman A. Effects of antidepressants on cognitive functioning of elderly patients: a review. Drugs Aging 1994 Sep; 5(3): 192–9PubMedCrossRefGoogle Scholar
  64. 64.
    Oxman TE. Antidepressants and cognitive impairment in the elderly. J Clin Psychiatry 1996; 57Suppl. 5: 38–44PubMedGoogle Scholar
  65. 65.
    Leo R. Movement disorders associated with the serotonin-selective reuptake inhibitors. J Clin Psychiatry 1996; 57: 449–54PubMedCrossRefGoogle Scholar
  66. 66.
    Richelson E. The pharmacology of antidepressants at the synapse: focus on newer compounds. J Clin Psychiatry 1994 Sep; 55Suppl. A: 34–9PubMedGoogle Scholar
  67. 67.
    Cusack B, Nelson A, Richelson E. Binding of antidepressants to human brain receptors: focus on the newer generation compounds. Psychopharmacology 1994 May; 114(4): 559–65PubMedCrossRefGoogle Scholar
  68. 68.
    Laghrissithode F, Pollock BG, Miller MC, et al. Double-blind comparison of paroxetine and nortriptyline on the postural stability of late-life depressed patients. Psychopharmacol Bull 1995; 31(4): 659–63Google Scholar
  69. 69.
    Preskorn SH. Recent pharmacologic advances in antidepressant treatment for the elderly. Am J Med 1993 May 24; 94Suppl. 5A: 2–12SGoogle Scholar
  70. 70.
    Rosenbaum J. Managing selective serotonin reuptake inhibitordrug interactions in clinical practice. Clin Pharmacokinet 1995; 29Suppl. 1: 53–9PubMedCrossRefGoogle Scholar
  71. 71.
    Amsterdam J, Brunswick D, Mendels J. The clinical application of tricyclic antidepressant pharmacokinetics and plasma levels. Am J Psychiatry 1980 Jun; 137(6): 653–62PubMedGoogle Scholar
  72. 72.
    Feighner JP, Cohn JB. Double-blind comparative trials of fluoxetine and doxepin in geriatric patients with major depressive disorder. J Clin Psychiatry 1985 Mar; 46(3): 20–5PubMedGoogle Scholar
  73. 73.
    Falk WE, Rosenbaum JF, Otto MW, et al. Fluoxetine versus trazodone in depressed geriatric patients. J Geriatr Psychiatry Neurol 1989; 2(4): 208–14PubMedCrossRefGoogle Scholar
  74. 74.
    Guillibert E, Pelcier Y, Archambault JC, et al. A double-blind multicenter study of paroxetine versus clomipramine in depressed elderly subjects. Acta Psychiatr Scand 1989; 80Suppl. 350: 132–4CrossRefGoogle Scholar
  75. 75.
    Cohn CK, Shirvastava R, Mendels J, et al. Double-blind, multicenter comparison of sertraline and amitriptyline in elderly depressed patients. J Clin Psychiatry 1990 Dec; 51Suppl. 12B: 28–33PubMedGoogle Scholar
  76. 76.
    Claghorn JL, Feighner JP. A double-blind comparison of paroxetine with imipramine in the long-term treatment of depression. J Clin Psychopharmacol 1993 Dec; 13(6): 23S–7SPubMedGoogle Scholar
  77. 77.
    Geretsegger C, Stuppaeck CH, Mair M, et al. Multicenter double blind study of paroxetine and amitriptyline in elderly depressed inpatients. Psychopharmacology 1995; 119: 277–81PubMedCrossRefGoogle Scholar
  78. 78.
    Miller FT, Freilicher J. Comparison of TCAs and SSRIs in the treatment of major depression in hospitalized geriatric patients. J Geriatr Psychiatry Neurol 1995 Jul; 8: 173–6PubMedGoogle Scholar
  79. 79.
    Glassman A, Ballenger J, Stokes P, et al. Tricyclic antidepressants: advantages and limitations. Geriatrics 1993 Nov; 48Suppl. 2: 6–8Google Scholar
  80. 80.
    Roose SP, Glassman AH, Attia E, et al. Comparative efficacy of selective serotonin reuptake inhibitors in the treatment of melancholia. Am J Psychiatry 1994 Dec; 151(12): 1735–9PubMedGoogle Scholar
  81. 81.
    Baldessarini RJ. Drugs and the treatment psychiatric disorders, depression and mania. In: Molinoff P, Ruddon R, editors. Goodman and Gilman’s the pharmacologic basis of therapeutics. 9th ed. New York: McGraw Hill, 1996: 431–59Google Scholar
  82. 82.
    Drevets WC. Geriatric depression: brain imaging correlates and pharmacologic considerations. J Clin Psychiatry 1994 Sep; 55Suppl. 9a: 71–81PubMedGoogle Scholar
  83. 83.
    Halikas JA. Org 3770 (mirtazapine) versus trazodone: a placebo-controlled trial in depressed elderly patients. Hum Psychopharmacol 1995; 10: S125–33CrossRefGoogle Scholar
  84. 84.
    Frazer A. Pharmacology of antidepressants. J Clin Psychopharmacol 1997; 2Suppl. 1: 2–18SCrossRefGoogle Scholar
  85. 85.
    Gurian B, Rosowsky E. Low-dose methylphenidate in the very old. J Geriatr Psychiatry Neurol 1990 Jul-Sep; 3(3): 152–4PubMedCrossRefGoogle Scholar
  86. 86.
    Wallace AE, Kofoed LL, West AN. Double-blind, placebo-controlled trial of methylphenidate in older, depressed, medically ill patients. Am J Psychiatry 1995 Jun; 152(6): 929–31PubMedGoogle Scholar
  87. 87.
    Georgotas A, McCue RE, Friedman E, et al. Response of depressive symptoms to nortriptyline, phenelzine and placebo. Br J Psychiatry 1987; 151: 102–6PubMedCrossRefGoogle Scholar
  88. 88.
    Georgotas A, McCue RE, Cooper TB, et al. How effective and safe is continuation therapy in elderly depressed patients? Arch Gen Psychiatry 1988; 45: 929–33PubMedCrossRefGoogle Scholar
  89. 89.
    Georgotas A, McCue RE, Cooper TB. A placebo-controlled comparison of nortriptyline and phenelzine in maintenance therapy of elderly depressed patients. Arch Gen Psychiatry 1989 Sep; 46: 783–6PubMedCrossRefGoogle Scholar
  90. 90.
    Sunderland T, Cohen RM, Molchan S, et al. High-dose selegiline in treatment-resistant older depressive patients. Arch Gen Psychiatry 1994 Aug; 51(8): 607–15PubMedCrossRefGoogle Scholar
  91. 91.
    Nair NP, Ahmed SK, Ng Ying Kin NM, et al. Reversible and selective inhibitors of monoamine oxidase A in the treatment of depressed elderly patients. Acta Psychiatr Scand 1995; 91Suppl. 386: 28–35CrossRefGoogle Scholar
  92. 92.
    Reynolds III CF, Lebowitz BD, Schneider LS. The NIH consensus development conference on the diagnosis and treatment of depression in late life. Psychopharmacol Bull 1993; 29(1): 83–95PubMedGoogle Scholar
  93. 93.
    Philibert RA, Richards L, Lynch CF, et al. Effect of ECT on mortality and clinical outcome in geriatric unipolar depression. J Clin Psychiatry 1995 Sep; 56(9): 390–4PubMedGoogle Scholar
  94. 94.
    Thompson LW, Gallagher D, Steinmetz-Breckenridge J. Comparative effectiveness of psychotherapies for depressed elders. J Consult Clin Psychology 1987; 55: 385–90CrossRefGoogle Scholar
  95. 95.
    Thompson LW. Cognitive-behavioral therapy and treatment for late-life depression. J Clin Psychiatry 1996; 57Suppl. 5: 29–37PubMedGoogle Scholar
  96. 96.
    Steuer JL, Mintz J, Hammen CL, et al. Cognitive-behavioral and psychodynamic group psychotherapy in the treatment of geriatric depression. J Consult Clin Psychology 1984; 52: 80–9CrossRefGoogle Scholar
  97. 97.
    Sadavoy J. Integrated psychotherapy for the elderly. Can J Psychiatry 1994; 39: S19–26PubMedGoogle Scholar
  98. 98.
    Scogin F, McElreath L. Efficacy of psychosocial treatments for geriatric depression: a quantitative review. J Consult Clin Psychology 1994; 62: 69–74CrossRefGoogle Scholar
  99. 99.
    Reynolds III CF. Treatment of depression in late life. Am J Med 1994; 97: 39S–46SPubMedCrossRefGoogle Scholar
  100. 100.
    Reynolds III CF, Frank E, Perel JM, et al. Combined pharmacotherapy and psychotherapy in the acute and continuation treatment of elderly patients with recurrent major depression: a preliminary report. Am J Psychiatry 1992; 149: 1687–92PubMedGoogle Scholar
  101. 101.
    Reynolds III CF, Frank E, Perel JM, et al. Maintenance therapies for late-life recurrent major depression: research and review circa 1995. Int Psychogeriatr 1995; 7: 27–39PubMedCrossRefGoogle Scholar
  102. 102.
    Hinrichsen GA, Hernandez NA. Factors associated with recovery from and relapse into major depressive disorder in the elderly. Am J Psychiatry 1993 Dec; 150(12): 1820–5PubMedGoogle Scholar
  103. 103.
    Kamath M, Finkel SI, Moran MB. A retrospective chart review of antidepressant use, effectiveness, and adverse effects in adults age 70 and older. Am J Geriatr Psychiatry 1996; 4: 167–72CrossRefGoogle Scholar
  104. 104.
    Reynolds III CF, Frank E, Perel JM, et al. Treatment of consecutive episodes of major depression in the elderly. Am J Psychiatry 1994 Dec; 151(12): 1740–3PubMedGoogle Scholar
  105. 105.
    Reynolds III CF. Recognition and differentiation of elderly depression in the clinical setting. Geriatrics 1995 Oct; 50Suppl. 1: S6–15PubMedGoogle Scholar
  106. 106.
    Kushnir SL. Lithium-antidepressant combination in the treatment of depressed, physically ill geriatric patients. Am J Psychiatry 1986; 143: 378–9PubMedGoogle Scholar
  107. 107.
    Flint AJ, Rifat SL. Aprospective study of lithium augmentation in antidepressant-resistant geriatric depression. J Clin Psychopharmacol 1994 Oct; 14(5): 353–6PubMedCrossRefGoogle Scholar
  108. 108.
    Weilburg JB, Rosenbaum JF, Biederman J, et al. Fluoxetine added to non-MAOI antidepressants converts nonresponders to responders: a preliminary report. J Clin Psychiatry 1989; 50: 447–9PubMedGoogle Scholar
  109. 109.
    Seth R, Jennings AL, Bindman J, et al. Combination treatment with noradrenaline and serotonin reuptake inhibitors in treatment resistant depression. Br J Psychiatry 1992; 161: 562–5PubMedCrossRefGoogle Scholar
  110. 110.
    Reynolds III CF, Frank E, Perel JM, et al. High relapse rate after discontinuation of adjunctive medication for elderly patients with recurrent major depression. Am J Psychiatry 1996 Nov; 153(11): 1418–22PubMedGoogle Scholar
  111. 111.
    Jorm AF. The epidemiology of depressive states in the elderly: implications for recognition, intervention and prevention. Soc Psychiatry Psychiatr Epidemiol 1995; 30: 53–9PubMedCrossRefGoogle Scholar
  112. 112.
    Lebowitz B. Diagnosis and treatment of depression in late life. Am J Geriatr Psychiatry 1996; 4Suppl. 1: S3–6Google Scholar
  113. 113.
    Pasternak RE, Reynolds III CF, Schlernitzauer M, et al. Acute open-trial of nortriptyline therapy of bereavement related depression in late life. J Clin Psychiatry 1991; 52: 307–10PubMedGoogle Scholar
  114. 114.
    Pasternak RE, Reynolds III CF, Frank E, et al. The temporal course of depressive symptoms and grief intensity in late-life spousal bereavement. Depression 1993; 1: 45–9CrossRefGoogle Scholar
  115. 115.
    Jacobs SC, Nelson JC, Zisook S. Treating depressions of bereavement with antidepressants: a pilot study. Psychiatr Clin North Am 1987; 10: 501–10PubMedGoogle Scholar
  116. 116.
    Prigerson HG, Frank E, Kasl SV, et al. Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses. Am J Psychiatry 1995 Jan; 152(1): 22–30PubMedGoogle Scholar
  117. 117.
    Prigerson HG, Bierhals AJ, Kasl SV, et al. Complicated grief as a disorder distinct from bereavement-related depression and anxiety: a replication study. Am J Psychiatry 1996 Nov; 153(11): 1484–6PubMedGoogle Scholar
  118. 118.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  119. 119.
    Blazer DG, Bachar JR, Manton KG. Suicide in late life: review and commentary. J Am Geriatr Soc 1986; 34: 519–25PubMedGoogle Scholar
  120. 120.
    Kanowski S. Age-dependent epidemiology of depression. Gerontology 1994; 40Suppl. 1: 1–4PubMedCrossRefGoogle Scholar
  121. 121.
    Danto BL, Danto JM. Psychiatric treatment of the elderly suicidal patient. In: Lester D, Tallmer M, editors. Now I lay me down: suicide in the elderly. Philadelphia: Charles Press, 1994: 43–55Google Scholar
  122. 122.
    Conwell Y, Rotenberg M, Caine ED. Completed suicide at age 50 and over. J Am Geriatr Soc 1990; 38: 640–4PubMedGoogle Scholar
  123. 123.
    Lyness JM, Conwell Y, Nelson JC. Suicide attempts in elderly psychiatric inpatients. J Am Geriatr Soc 1992; 40: 320–4PubMedGoogle Scholar
  124. 124.
    Szanto K, Reynolds III CF, Frank E, et al. Suicide in elderly depressed patients: is active vs passive suicidal ideation a clinically valid distinction? Am J Geriatr Psychiatry 1996; 4: 197–207CrossRefGoogle Scholar
  125. 125.
    Blazer D, Bachar JR, Hughes DC. Major depression with melancholia: a comparison of middle-aged and elderly adults. J Am Geriatr Soc 1987; 35: 927–32PubMedGoogle Scholar
  126. 126.
    Zweig RA, Hinrichsen GA. Factors associated with suicide attempts by depressed older adults: a prospective study. Am J Psychiatry 1993; 150: 1687–92PubMedGoogle Scholar
  127. 127.
    Jones JS, Stanley B, Mann JJ, et al. CSF 5-HIAA and HVA concentrations in elderly depressed patients who attempted suicide. Am J Psychiatry 1990; 147: 1225–7PubMedGoogle Scholar
  128. 128.
    Nordström P, Samuelsson M, Åsberg M, et al. CSF 5-HIAA predicts suicide risk after attempted suicide. Suicide Life Threat Behav 1994; 24: 1–9PubMedGoogle Scholar
  129. 129.
    McIntosh JL, Santos JF, Hubbard RW, et al. Elder suicide: research, theory, and treatment. Washington, DC: American Psychological Association, 1994: 127–31CrossRefGoogle Scholar
  130. 130.
    Meehan PJ, Saltzman LE, Sattin RW. Suicides among older United States residents: epidemiologic characteristics and trends. Am J Pub Health 1991; 81: 1198–200CrossRefGoogle Scholar
  131. 131.
    Tallmer M. Symptoms and assessment of suicide in the elderly patient. In: Lester D, Tallmer M, editors. Now I lay me down: suicide in the elderly. Philadelphia: Charles Press, 1994: 17–30Google Scholar
  132. 132.
    Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the scale for suicide ideation. J Consult Clin Psychology 1979; 47: 343–52CrossRefGoogle Scholar
  133. 133.
    Beck AT, Steer RA, Kovacs M, et al. Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry 1985; 142: 559–63PubMedGoogle Scholar
  134. 134.
    Rifai AH, George CJ, Stack JA, et al. Hopelessness in suicide attempters after acute treatment of major depression in late life. Am J Psychiatry 1994; 151: 1687–90PubMedGoogle Scholar
  135. 135.
    Schifano F. Pharmacological strategies for preventing suicidal behaviour. CNS Drugs 1994; 1(1): 16–25CrossRefGoogle Scholar
  136. 136.
    Murray C, Lopez AD, editors. The global burden of disease. Cambridge (MA): Harvard University Press, 1996: 375–85Google Scholar

Copyright information

© Adis International Limited 1998

Authors and Affiliations

  • Robert Lasser
    • 1
  • Erika Siegel
    • 2
  • Ruth Dukoff
    • 1
  • Trey Sunderland
    • 1
  1. 1.Geriatric Psychiatry BranchNational Institute of Mental HealthBethesdaUSA
  2. 2.Department of PsychologyThe Catholic University of AmericaWashingtonUSA

Personalised recommendations