Treating depression in later life

The three major mental health problems affecting older people are dementia, delirium, and depression. Depressive disorders are the most common, affecting one in seven, a prevalence rate that is consistent across countries and cultures.1 Comparable rates for dementia and delirium are one in 17 and one in 25. Therapeutic optimism surrounds the management of dementia and delirium, but the development of new management approaches in late life depression has been neglected, perhaps because of stigma. Twenty years ago, a rule of three was proposed in this journal: a third of older depressed people get better, a third remain the same, and a third get worse.2 This rule is still applicable today despite the availability and efficacy of treatments that could substantially improve these ratios. Depression late in life is associated with serious morbidity and mortality, including suicide.3 The national service framework for older people targets stroke, falls, dementia, and depression, but only the first three seem to attract …