Treatment of Depression in the Elderly

Abstract

It is still inadequately recognised that the term ‘depression’, like so many others in psychiatry, takes in its medical context a meaning somewhat different from that of its normal lay usage, and from this failure of recognition arise many of the difficulties that are experienced in the diagnosis and treatment of the syndrome. Clinical depression is more than a mere alteration mood; it is,a true ‘depression’ of a range of vital functions. There is depression of activity, of appetite, communicative ability, memory, gastro-intestinal function and sleep, there is alteration of endocrine function and there is distorted and pathological thinking. Illness is defined as loss of function, and thus clinical depression can be regarded as a true illness, many of its functional impairments being life-threatening, especially in elderly people. The incidence of suicide in the elderly is high^1,2 but death and chronic morbidity are just as likely, indeed more likely, to arise from self-neglect and its consequences, Malnutrition, accidents, pressure sores, and deep venous thrombosis are Just some of the dismal results of depressive illness, and perhaps of even greater concern is the insidious loss of independence that overtakes old people in hospital when their condition has not been speedily recognized and treated.