Skip to main content
SpringerLink
Log in

Depression in the elderly: new concepts and therapeutic approaches

  • Review Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Depression is one of the leading causes of suffering in the elderly, but it is often under-diagnosed and under-treated, partly due to the false belief that depression is a common aspect of aging. Depression in the elderly is frequently comorbid with medical illnesses, may often be expressed by somatic complaints, and may be a risk factor for other diseases such as dementia and coronary artery disease. Depression decreases the quality of life and increases disability and the risk of mortality, also due to suicide. Although several effective antidepressant drugs are available, with a favorable therapeutic index, non-pharmacological treatments, such as psychotherapy and exercise, should receive greater attention, since combination therapy is probably more effective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wells KB, Sturm R, Sherbourne CD, Meredith LS. Caring for depression. Cambridge (MA): Harvard University Press, 1996.

    Google Scholar 

  2. Murray CJ, Lopez AD. Evidence-based health policy-lessons from the global burden of disease study. Science 1996; 274: 740–3.

    Article  PubMed  CAS  Google Scholar 

  3. Lecrubier Y. Prescribing patterns for depression and anxiety worldwide. J Clin Psychiatry 2001; 62 (Suppl 13): 31–6.

    PubMed  Google Scholar 

  4. Lepine JP, Gastpar M, Mendlewicz J, Tylee A. Depression in the community: the first pan-European study DEPRES (Depression Research in European Society). Int Clin Psychopharmacol 1997; 12: 19–29.

    Article  PubMed  CAS  Google Scholar 

  5. Ernst C, Angst J. Depression in old age: is there a real decrease in prevalence? A review. Eur Arch Psychiatry Clin Neurosci 1995; 245: 272–87.

    Article  PubMed  CAS  Google Scholar 

  6. Beekman ATF, Copeland JRM, Prince MJ. Review of community prevalence of depression in later life. Br J Psychiatry 1999; 174: 307–11.

    Article  PubMed  CAS  Google Scholar 

  7. Schieman S, van Gundy K, Taylor J. The relationship between age and depressive symptoms: a test of competing explanatory and suppression influences. J Aging Health 2002; 14: 260–85.

    Article  PubMed  Google Scholar 

  8. Weissman MM, Bruce ML, Leaf PJ, Florio LP, Holzer CE. Affective disorders. In Robins LN, Regier DA, Eds. Psychiatric disorders in America: the epidemiologic catchment area study. New York (NY): The Free Press, 1991: 53–80.

    Google Scholar 

  9. Mirowsky J, Reynolds J. Age, depression, and attrition in the National Survey of Families and Households. Sociol Methods Res 2000; 28: 476–504.

    Article  Google Scholar 

  10. Roberts RE, Kaplan GA, Shema SJ, Strawbridge WJ. Prevalence and correlates of depression in an aging cohort: the Alameda County Study. J Gerontol 1997; 52: S252–8.

    CAS  Google Scholar 

  11. Blazer D, Hughes D, George L. The epidemiology of depression in an elderly community population. Gerontologist 1987; 27: 281–7.

    Article  PubMed  CAS  Google Scholar 

  12. Steffens D, Skook I, Norton MC. Prevalence of depression and its treatment in an elderly population: the Cache County study. Arch Gen Psychiatry 2000; 57: 601–7.

    Article  PubMed  CAS  Google Scholar 

  13. Lyness JM, King DA, Cox C, Yoediono Z, Caine ED. The importance of subsyndromal depression in older primary care patients: prevalence and associated functional disability. J Am Geriatr Soc 1999; 47: 647–62.

    PubMed  CAS  Google Scholar 

  14. Blazer DG, Hybels CF, Pieper CF. The association of depression and mortality in elderly persons: a case for multiple, independent pathways. J Gerontol 2001; 56: M505–9.

    Article  CAS  Google Scholar 

  15. Minicuci N, Maggi S, Pavan M, Enzi G, Crepaldi G. Prevalence rate and correlates of depressive symptoms in older individuals: the Veneto Study. J Gerontol 2002; 57: M155–61.

    Article  Google Scholar 

  16. Palsson S, Skoog I. The epidemiology of affective disorders in the elderly: a review. Int Clin Psychopharmacol 1997; 12 (Suppl 7): S3–13.

    Article  PubMed  Google Scholar 

  17. Kua EH. Depressive disorder in elderly Chinese people. Acta Psychiatr Scand 1990; 81: 386–8.

    Article  PubMed  CAS  Google Scholar 

  18. Kramer M, German PS, Anthony JC, Von Korff M, Skinner EA. Patterns of mental disorders among elderly residents of eastern Baltimore. J Am Geriatr Soc 1985; 33: 236–45.

    PubMed  CAS  Google Scholar 

  19. Blazer D, Burchett B, Service C, George L. The association of age and depression among the elderly: an epidemiologic exploration. J Gerontol 1991; 46: M210–5.

    Article  PubMed  CAS  Google Scholar 

  20. Beekman A, Deeg D, van Tilberg T, Smit J, Hooijer C, van Tilberg W. Major and minor depression in later life: a study of prevalence and risk factors. J Affect Disord 1995; 36: 65–75.

    Article  PubMed  CAS  Google Scholar 

  21. Fitcher MM, Bruce ML, Schroppel H, Meller I, Merikangas K. Cognitive impairment and depression in the oldest old in a German and in U.S. communities. Eur Arch Psychiatry Clin Neurosci 1995; 245: 319–25.

    Article  Google Scholar 

  22. Forsell Y, Corder EH, Basun H, Lannfelt L, Viitanen M, Winblad B. Depression and dementia in relation to apolipoprotein E polymorphism in a population sample age 75+. Biol Psychiatry 1997; 42: 898–903.

    Article  PubMed  CAS  Google Scholar 

  23. Lobo A, Saz P, Marcos G, Dia JL, De-la-Camara C. The prevalence of dementia and depression in the elderly community in a southern European population. The Zaragoza study. Arch Gen Psychiatry 1995; 52: 497–506.

    Article  CAS  Google Scholar 

  24. Schoevers RA, Geerlings MI, Beeckman ATF, et al. Association of depression and gender with mortality in old age. Results from the Amsterdam Study of the Elderly (AMSTEL). Br J Psychiatry 2000; 177: 336–42.

    PubMed  CAS  Google Scholar 

  25. Lyness JM, Caine E, King D, Conwell Y, Duberstein P, Cox C. Depressive disorders and symptoms in older primary care patients. Am J Geriatr Psychiatr 2002; 10: 275–82.

    Google Scholar 

  26. Pouget R, Yersin B, Wietlisbach V, Bumand B, Bula CJ. Depressed mood in a cohort of elderly medical inpatients: prevalence, clinical correlates and recognition rate. Aging Clin Exp Res 2000; 12: 301–7.

    CAS  Google Scholar 

  27. Rinaldi P, Mecocci P, Benedetti C, et al. Validation of the five-item geriatric depression scale in elderly subjects in three different settings. J Am Geriatr Soc 2003; 51: 694–8.

    Article  PubMed  Google Scholar 

  28. Parmelee P, Katz I, Lawton M. Depression among institutionalized aged: assessment and prevalence estimation. J Gerontol 1989; 44: M22–9.

    Article  PubMed  CAS  Google Scholar 

  29. Sevick MA, Rolih C, Pahor M. Gender differences in morbidity and mortality related to depression: A review of the literature. Aging Clin Exp Res 2000; 12: 407–16.

    CAS  Google Scholar 

  30. Gottfries CG. Is there a difference between elderly and younger patients with regard to the symptomatology and aetiology of depression? Int Clin Psychopharmacol 1998; 13 (Suppl 5): 13–8.

    Article  Google Scholar 

  31. Blazer DG, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national community sample: the national comorbidity survey. Am J Psychiatry 1994; 151: 979–86.

    PubMed  CAS  Google Scholar 

  32. Lehtinen V, Joukamaa M. Epidemiology of depression: prevalence, risk factors and treatment situation. Acta Psychiatr Scand 1994; 83 (Suppl 377): 7–10.

    Article  Google Scholar 

  33. Bebbington PE, Dunn G, Jenkins R, et al. The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity. Psychol Med 1998; 28: 9–19.

    Article  PubMed  CAS  Google Scholar 

  34. Lindeman S, Hämäläinen J, Isometsä E, et al. The 12-month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults. Acta Psychiatr Scand 2000; 102: 178–84.

    Article  PubMed  CAS  Google Scholar 

  35. Sonnenberg CM, Beekman ATF, Deeg DJH, van Tilburg W. Sex differences in late-life depression. Acta Psychiatr Scand 2000; 101: 286–92.

    PubMed  CAS  Google Scholar 

  36. Silverstein B. Gender differences in the prevalence of clinical depression: the role played by depression associated with somatic symptoms. Am J Psychiatry 1999; 156: 480–2.

    PubMed  CAS  Google Scholar 

  37. Stordal E, Bjartveit Krüger M, Dahl NH, Krüger Mykletun A, Dahl AA. Depression in relation to age and gender in the general population: the Nord-Trondelag Health Study (HUNT). Acta Psychiatr Scand 2001; 104: 210–6.

    Article  PubMed  CAS  Google Scholar 

  38. Schoevers RA, Beekman AT, Deeg DJ, Hooijer C, Jonker C, van Tilburg W. The natural history of late-life depression: results from the Amsterdam Study of the Elderly (AMSTEL). J Affect Disord 2003; 76: 5–14.

    Article  PubMed  CAS  Google Scholar 

  39. Schoevers RA, Geerlings MI, Beekman AT, et al. Association of depression and gender with mortality in old age. Results from the Amsterdam Study of the Elderly (AMSTEL). Br J Psychiatry 2000; 177: 336–42.

    PubMed  CAS  Google Scholar 

  40. Cronin-Stubbs D, de Leon CF, Beckett LA, Field TS, Glynn RJ, Evans DA. Six-year effect of depressive symptoms on the course of physical disability in community-living older adults. Arch Intern Med 2000; 160: 3074–80.

    Article  PubMed  CAS  Google Scholar 

  41. Fried LP, Guralnik JM. Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc 1997; 45: 92–100.

    PubMed  CAS  Google Scholar 

  42. Charlson M, Peterson JC. Medical comorbidity and late life depression: what is known and what are the unmet needs? Biol Psy-chiatry 2002; 52: 226–35.

    Article  Google Scholar 

  43. Koenig HG, George LK, Peterson BL, Pieper CF. Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes. Am J Psychiatry 1997; 154: 1376–83.

    PubMed  CAS  Google Scholar 

  44. Blazer DG. Late life affective disorders. Arch Gerontol Geriatr 1998; Suppl. 6: 43–7.

    Article  Google Scholar 

  45. Kockler M, Heun R. Gender differences of depressive symptoms in depressed and nondepressed elderly persons. Int J Geriatr Psychiatry 2002; 17: 65–72

    Article  PubMed  CAS  Google Scholar 

  46. Beekman AT, de Beurs E, van Balkom AJ, Deeg DJ, van Dyck R, van Tilburg W. Anxiety and depression in later life: Co-occurrence and communality of risk factors. Am J Psychiatry 2000; 157: 89–95.

    PubMed  CAS  Google Scholar 

  47. Lenze EJ, Mulsant BH, Shear MK, et al. Comorbid anxiety disorders in depressed elderly patients. Am J Psychiatry 2000; 157: 722–8.

    Article  PubMed  CAS  Google Scholar 

  48. Lenze EJ, Mulsant BH, Shear MK, Alexopoulos GS, Frank E, Reynolds CF 3rd. Comorbidity of depression and anxiety disorders in later life. Depress Anxiety 2001; 14: 86–93.

    Article  PubMed  CAS  Google Scholar 

  49. Devanand DP. Comorbid psychiatric disorders in late life depression. Biol Psychiatry 2002; 52: 236–42.

    Article  PubMed  CAS  Google Scholar 

  50. Alexopoulos GS, Buckwalter K, Olin J, Martinez R, Wainscott C, Krishnan KR. Comorbidity of late life depression: an opportunity for research on mechanisms and treatment. Biol Psychiatry 2002; 52: 543–58.

    Article  PubMed  Google Scholar 

  51. Covinsky KE, Kahana E, Chin MH, Palmer RM, Fortinsky RH, Landefeld CS. Depressive symptoms and 3-year mortality in older hospitalized medical patients. Ann Intern Med 1999; 130: 563–9.

    Article  PubMed  CAS  Google Scholar 

  52. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001; 24: 1069–78.

    Article  PubMed  CAS  Google Scholar 

  53. O’Connor CM, Gurbel PA, Serebruany VL. Depression and ischemic heart disease. Am Heart J 2000; 140 (Suppl 4): 63–9.

    Article  PubMed  Google Scholar 

  54. Koenig HG. Depression in hospitalized older patients with congestive heart failure. Gen Hosp Psychiatry 1998; 20: 29–43.

    Article  PubMed  CAS  Google Scholar 

  55. Chochinov HM. Depression in cancer patients. Lancet Oncol 2001; 2: 499–505.

    Article  PubMed  CAS  Google Scholar 

  56. Patten SB. Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2. J Affect Disord 2001; 63: 35–41.

    Article  PubMed  CAS  Google Scholar 

  57. Katona C, Livingston G, Manela M, et al. The symptomatology of depression in the elderly. Int Clin Psychopharmacol 1997; 12 (Suppl 7): S19–23.

    Article  PubMed  Google Scholar 

  58. Unutzer J, Patrick DL, Simon G, et al. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. A 4-year prospective study. JAMA 1997; 277: 1618–23.

    Article  PubMed  CAS  Google Scholar 

  59. Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. “Vascular depression” hypothesis. Arch Gen Psychiatry 1997; 54: 915–22.

    Article  PubMed  CAS  Google Scholar 

  60. Ormel J, Rijsdijk FV, Sullivan M, van Sonderen E, Kempen GI. Temporal and reciprocal relationship between IADL/ADL disability and depressive symptoms in late life. J Gerontol 2002; 57: P338–47.

    Article  Google Scholar 

  61. Rugulies R. Depression as a predictor for coronary heart disease, a review and meta-analysis. Am J Prev Med 2002; 23: 51–61.

    Article  PubMed  Google Scholar 

  62. Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000; 160: 3278–85.

    Article  PubMed  CAS  Google Scholar 

  63. Wang PS, Bohn RL, Knight E, Glynn RJ, Mogun H, Avorn J. Noncompliance with antihypertensive medications: the impact of depressive symptoms and psychosocial factors. J Gen Intern Med 2002; 17: 504–11.

    Article  PubMed  Google Scholar 

  64. Druss BG, Rosenheck RA, Desai MM, Perlin JB. Quality of preventive medical care for patients with mental disorders. Med Care 2002; 40: 129–36.

    Article  PubMed  Google Scholar 

  65. Katon WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry 2003; 54: 216–26.

    Article  PubMed  Google Scholar 

  66. Whyte EM, Mulsant BH. Post-stroke depression: epidemiology, pathophysiology, and biological treatment. Biol Psychiatry 2002; 52: 253–64.

    Article  PubMed  Google Scholar 

  67. Coffey CE, Figiel GS, Djang WT, Weiner RD. Subcortical hyperintensity on magnetic resonance imaging: a comparison of normal and depressed elderly subjects. Am J Psychiatry 1990; 147: 187–9.

    PubMed  CAS  Google Scholar 

  68. Murata T, Kimura H, Omori M, et al. MRI white matter hyperintensities, (1)H-MR spectroscopy and cognitive function in geriatric depression: a comparison of early- and late-onset cases. Int J Geriatr Psychiatry 2001; 16: 1129–35.

    Article  PubMed  CAS  Google Scholar 

  69. Steffens DC, Conway CR, Dombeck CB, Wagner HR, Tupler LA, Weiner RD. Severity of subcortical gray matter hyperintensity predicts ECT response in geriatric depression. J ECT 2001; 17: 45–9.

    Article  PubMed  CAS  Google Scholar 

  70. Krishnan KR, Hays JC, Blazer DG. MRI-defined vascular depression. Am J Psychiatry 1997; 154: 497–501.

    PubMed  CAS  Google Scholar 

  71. Alexopoulos GS, Kiosses DN, Klimstra S, Kalayam B, Bruce ML. Clinical presentation of the “depression-executive dysfunction syndrome” of late life. Am J Geriatr Psychiatry 2002; 10: 98–106.

    PubMed  Google Scholar 

  72. Romanelli J, Fauerbach JA, Bush DE, Ziegelstein RC. The significance of depression in older patients after myocardial infarction. J Am Geriatr Soc 2002; 50: 817–22

    Article  PubMed  Google Scholar 

  73. Carney RM, Freedland KE. Depression, mortality, and medical morbidity in patients with coronary heart disease. Biol Psychiatry 2003; 54: 241–7.

    Article  PubMed  Google Scholar 

  74. Penninx BW, Beekman AT, Honig A, et al. Depression and cardiac mortality: results from a community-based longitudinal study. Arch Gen Psychiatry 2001; 58: 221–7.

    Article  PubMed  CAS  Google Scholar 

  75. Penninx BW, Guralnik JM, Mendes de Leon CF, et al. Cardiovascular events and mortality in newly and chronically depressed persons >70 years of age. Am J Cardiol 1998; 81: 988–94.

    Article  PubMed  CAS  Google Scholar 

  76. Maas JW, Katz MM, Koslow SH, et al. Adrenomedullary function in depressed patients. J Psychiatr Res 1994; 28: 357–67.

    Article  PubMed  CAS  Google Scholar 

  77. Ehlert U, Gaab J, Heinrichs M. Psychoneuroendocrinological contributions to the etiology of depression, post-traumatic stress disorder, and stress-related bodily disorders: the role of the hypothalamus-pituitary-adrenal axis. Biol Psychol 2001; 57: 141–52.

    Article  PubMed  CAS  Google Scholar 

  78. Carney RM, Saunders RD, Freedland KE, Stein P, Rich MW, Jaffe AS. Association of depression with reduced heart rate variability in coronary artery disease. Am J Cardiol 1995; 76: 562–4.

    Article  PubMed  CAS  Google Scholar 

  79. Stein PK, Carney RM, Freedland KE, et al. Severe depression is associated with markedly reduced heart rate variability in patients with stable coronary heart disease. J Psychosom Res 2000; 48: 493–500.

    Article  PubMed  CAS  Google Scholar 

  80. Whyte E, Pollock BG, Wagner W, et al. Influence of serotonin transporter-linked region polymorphism on platelet activation in geriatric depression. Am J Psychiatr 2001; 158: 2074–6.

    Article  PubMed  CAS  Google Scholar 

  81. Laghrissi-Thode F, Wagner WR, Pollock BG, Johnson PC, Finkel MS. Elevated platelet factor 4 and beta-thromboglobulin plasma levels in depressed patients with ischemic heart disease. Biol Psychiatry 1997; 42: 290–5.

    Article  PubMed  CAS  Google Scholar 

  82. Kop WJ, Gottdiener JS, Tangen CM, et al. Inflammation and coagulation factors in persons >65 years of age with symptoms of depression but without evidence of myocardial ischemia. Am J Cardiol 2002; 89: 419–24.

    Article  PubMed  CAS  Google Scholar 

  83. Sauer WH, Berlin JA, Kimmel SE. Effect of antidepressants and their relative affinity for the serotonin transporter on the risk of myocardial infarction. Circulation 2003; 108: 32–6.

    Article  PubMed  CAS  Google Scholar 

  84. Glassman AH, O’Connor CM, Califf RM, et al. Sertraline Antidepressant Heart Attack Randomized Trial (SADHEART) Group. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002; 288: 701–9.

    PubMed  CAS  Google Scholar 

  85. Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) randomized trial. JAMA 2003; 289: 3106–16.

    Article  PubMed  Google Scholar 

  86. McGuirew MH, Rabins PV. Mood disorders. In Coffey CE, Cummings JL, Eds. Textbook of Geriatric Neuropsychiatry. Washington, DC: American Psychiatric Press, 1994: 240–60.

    Google Scholar 

  87. Teri L, Wagner AW. Assessment of depression in patients with Alzheimer’s disease: concordance among informants. Psychol Aging 1991; 6: 280–5.

    Article  PubMed  CAS  Google Scholar 

  88. Gonzalez-Salvador T, Lyketsos CG, Baker A, et al. Quality of life in dementia patients in long-term care. Int J Geriatr Psychiatry 2000; 15: 181–9.

    Article  PubMed  CAS  Google Scholar 

  89. Lyketsos CG, Steele C, Baker L, et al. Major and minor depression in Alzheimer’s disease: prevalence and impact. J Neuropsychiatry Clin Neurosci 1997; 9: 556–61.

    PubMed  CAS  Google Scholar 

  90. Gonzalez-Salvador MT, Arango C, Lyketsos CG, Barba AC. The stress and psychological morbidity of the Alzheimer patient caregiver. Int J Geriatr Psychiatry 1999; 14: 701–10.

    Article  PubMed  CAS  Google Scholar 

  91. Steele C, Rovner B, Chase GA, Folstein M. Psychiatric symptoms and nursing home placement of patients with Alzheimer’s disease. Am J Psychiatry 1990; 147: 1049–51.

    PubMed  CAS  Google Scholar 

  92. Lee HB, Lyketsos CG. Depression in Alzheimer’s disease: heterogeneity and related issues. Biol Psychiatry 2003; 54: 353–62.

    Article  PubMed  CAS  Google Scholar 

  93. Ballard CG, Bannister C, Oyebode F. A review - Depression in dementia sufferers. Int J Geriatr Psychiatry 1996; 11: 507–15.

    Article  Google Scholar 

  94. Cummings JL, Miller B, Hill MA, Neshkes R. Neuropsychiatric aspects of multi-infarct dementia and dementia of the Alzheimer type. Arch Neurol 1987; 44: 389–93.

    Article  PubMed  CAS  Google Scholar 

  95. Reichman WE, Coyne AC. Depressive symptoms in Alzheimer’s disease and multi-infarct dementia. J Geriatr Psychiatry Neurol 1995; 8: 96–9.

    PubMed  CAS  Google Scholar 

  96. Newman SC. The prevalence of depression in Alzheimer’s disease and vascular dementia in a population sample. J Affect Disord 1999; 52: 169–76.

    Article  PubMed  CAS  Google Scholar 

  97. Ballard C, Neill D, O’Brien J, McKeith IG, Ince P, Perry R. Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Disord 2000; 59: 97–106.

    Article  PubMed  CAS  Google Scholar 

  98. Simpson S, Allen H, Tomenson B, Burns A. Neurological correlates of depressive symptoms in Alzheimer’s disease and vascular dementia. J Affect Disord 1999; 53: 129–36.

    Article  PubMed  CAS  Google Scholar 

  99. Devanand DP, Sano M, Tang MX, et al. Depressed mood and the incidence of Alzheimer’s disease in the elderly living in the community. Arch Gen Psychiatry 1996; 53: 75–182.

    Article  Google Scholar 

  100. Bassuk SS, Berkman LF, Wypij D. Depressive symptomatology and incident cognitive decline in an elderly community sample. Arch Gen Psychiatry 1998; 55: 1073–81.

    Article  PubMed  CAS  Google Scholar 

  101. Yaffe K, Blackwell T, Gore R, Sands L, Reus V, Browner WS. Depressive symptoms and cognitive decline in nondemented elderly women: a prospective study. Arch Gen Psychiatry 1999; 56: 425–30.

    Article  PubMed  CAS  Google Scholar 

  102. Steffens DC, Plassman BL, Helms MJ, Welsh-Bohmer KA, Saunders AM, Breitner JC. A twin study of late-onset depression and apolipoprotein E epsilon 4 as risk factors for Alzheimer’s disease. Biol Psychiatry 1997; 41: 851–6.

    Article  PubMed  CAS  Google Scholar 

  103. Chen P, Ganguli M, Mulsant BH, DeKosky ST. The temporal relationship between depressive symptoms and dementia: a community-based prospective study. Arch Gen Psychiatry 1999; 56: 261–6.

    Article  PubMed  CAS  Google Scholar 

  104. Speck CE, Kukull WA, Brenner DE, et al. History of depression as a risk factor for Alzheimer’s disease. Epidemiology 1995; 6: 366–9.

    Article  PubMed  CAS  Google Scholar 

  105. Jorm AF, van Duijn CM, Chandra V, et al. Psychiatric history and related exposures as risk factors for Alzheimer’s disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group. Int J Epidemiol 1991; 20 (Suppl 2): S43–7.

    Article  PubMed  Google Scholar 

  106. Jorm AF. Is depression a risk factor for dementia or cognitive decline? A review. Gerontology 2000; 46: 219–27.

    Article  PubMed  CAS  Google Scholar 

  107. Wilson RS, Barnes LL, Mendes de Leon CF, et al. Depressive symptoms, cognitive decline, and risk of AD in older persons. Neurology 2002; 59: 364–70.

    Article  PubMed  Google Scholar 

  108. Green RC, Cupples LA, Kurz A, et al. Depression as a risk factor for Alzheimer disease: the MIRAGE Study. Arch Neurol 2003; 60: 753–9.

    Article  PubMed  Google Scholar 

  109. Zarow C, Lyness SA, Mortimer JA, Chui HC. Neuronal loss is greater in the locus coeruleus than nucleus basalis and substantia nigra in Alzheimer and Parkinson diseases. Arch Neurol 2003; 60: 337–41.

    Article  PubMed  Google Scholar 

  110. Zweig RM, Ross CA, Hedreen JC, et al. The neuropathology of aminergic nuclei in Alzheimer’s disease. Ann Neurol 1988; 24: 233–42.

    Article  PubMed  CAS  Google Scholar 

  111. Zubenko GS. Biological correlates of clinical heterogeneity in primary dementia. Neuropsychopharmacology 1992; 6: 77–93.

    PubMed  CAS  Google Scholar 

  112. Alexopoulos GS, Young RC, Shindledecker RD. Brain computed tomography findings in geriatric depression and primary degenerative dementia. Biol Psychiatry 1992; 31: 591–9.

    Article  PubMed  CAS  Google Scholar 

  113. Laakso MP, Soininen H, Partanen K, et al. Volumes of hippocampus, amygdala and frontal lobes in the MRI-based diagnosis of early Alzheimer’s disease: correlation with memory functions. J Neural Transm Park Dis Dement Sect 1995; 9: 73–86.

    Article  PubMed  CAS  Google Scholar 

  114. Rabins PV, Pearlson GD, Aylward E, Kumar AJ, Dowell K. Cortical magnetic resonance imaging changes in elderly inpatients with major depression. Am J Psychiatry 1991; 148: 617–20.

    PubMed  CAS  Google Scholar 

  115. Coffey CE, Wilkinson WE, Weiner RD, et al. Quantitative cerebral anatomy in depression. A controlled magnetic resonance imaging study. Arch Gen Psychiatry 1993; 50: 7–16.

    CAS  Google Scholar 

  116. Pantel J, Schroder J, Schad LR, et al. Quantitative magnetic resonance imaging and neuropsychological functions in dementia of the Alzheimer type. Psychol Med 1997; 27: 221–9.

    Article  PubMed  CAS  Google Scholar 

  117. Bremner JD, Narayan M, Anderson ER, Staib LH, Miller HL, Charney DS. Hippocampal volume reduction in major depression. Am J Psychiatry 2000; 157: 115–8.

    Article  PubMed  CAS  Google Scholar 

  118. Steffens DC, Byrum CE, McQuoid DR, et al. Hippocampal volume in geriatric depression. Biol Psychiatry 2000; 48: 301–9.

    Article  PubMed  CAS  Google Scholar 

  119. Soares JC, Mann JJ. The anatomy of mood disorders. Review of structural neuroimaging studies. Biol Psychiatry 1997; 41: 86–106.

    CAS  Google Scholar 

  120. Lesser IM, Boone KB, Mehringer CM, Wohl MA, Miller BL, Berman NG. Cognition and white matter hyperintensities in older depressed patients. Am J Psychiatry 1996; 153: 1280–7.

    PubMed  CAS  Google Scholar 

  121. Jenkins M, Malloy P, Salloway S, et al. Memory processes in depressed geriatric patients with and without subcortical hyperintensities on MRI. J Neuroimaging 1998; 8: 20–6.

    PubMed  CAS  Google Scholar 

  122. Hickie I, Scott E, Wilhelm K, Brodaty H. Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression: a longitudinal evaluation. Biol Psychiatry 1997; 42: 367–74.

    Article  PubMed  CAS  Google Scholar 

  123. Krishnan KR, Tupler LA, Ritchie JC Jr, et al. Apolipoprotein Eepsilon 4 frequency in geriatric depression. Biol Psychiatry 1996; 40: 69–71.

    Article  PubMed  CAS  Google Scholar 

  124. Rigaud AS, Traykov L, Caputo L, et al. Association of the apolipoprotein E epsilon 4 allele with late-onset depression. Neuroepidemiology 2001; 20: 268–72.

    Article  PubMed  CAS  Google Scholar 

  125. Muller-Thomsen T, Arlt S, Ganzer S, et al. Depression in Alzheimer’s disease might be associated with apolipoprotein E epsilon 4 allele frequency in women but not in men. Dement Geriatr Cogn Disord 2002; 14: 59–63.

    Article  PubMed  Google Scholar 

  126. Zubenko GS, Henderson R, Stiffler JS, Stabler S, Rosen J, Kaplan BB. Association of the APOE epsilon 4 allele with clinical subtypes of late life depression. Biol Psychiatry 1996; 40: 1008–16.

    Article  PubMed  CAS  Google Scholar 

  127. Forsell Y, Jorm AF, von Strauss E, Winblad B. Prevalence and correlates of depression in a population of nonagenarians. Br J Psychiatry 1995; 167: 61–4.

    Article  PubMed  CAS  Google Scholar 

  128. Scarmeas N, Brandt J, Albert M, et al. Association between the APOE genotype and psychopathologic symptoms in Alzheimer’s disease. Neurology 2002; 58: 1182–8.

    Article  PubMed  CAS  Google Scholar 

  129. Berkman LF, Berkman CS, Kasl S, et al. Depressive symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol 1986; 124: 372–88.

    PubMed  CAS  Google Scholar 

  130. Blazer DG. Depression in late life: review and commentary. J Gerontol 2003; 58: 249–65.

    Google Scholar 

  131. Penninx B, Leveille S, Ferrucci L, van Eijk J, Guralnik J. Exploring the effect of depression on physical disability: longitudinal evidence from the Established Populations for Epidemiologic Studies of the Elderly. Am J Publ Health 1999; 89: 1346–52.

    Article  CAS  Google Scholar 

  132. Kivela SL, Pahkala K, Laippala P. Prevalence of depression in an elderly population in Finland. Acta Psychiatr Scand 1988; 78: 401–13.

    Article  PubMed  CAS  Google Scholar 

  133. Mossey JM, Knott K, Craik R. The effects of persistent depressive symptoms on hip fracture recovery. J Gerontol 1990; 45: M163–8.

    Article  PubMed  CAS  Google Scholar 

  134. Coulehan JL, Schulberg HC, Block MR, Madonia MJ, Rodriguez E. Treating depressed primary care patients improves their physical, mental, and social functioning. Arch Intern Med 1997; 157: 1113–20.

    Article  PubMed  CAS  Google Scholar 

  135. Oslin DW, Streim J, Katz IR, Edell WS, TenHave T. Change in disability follows inpatient treatment for late life depression. J Am Geriatr Soc 2000; 48: 357–62.

    PubMed  CAS  Google Scholar 

  136. Kiosses DN, Klimstra S, Murphy C, Alexopoulos GS. Executive dysfunction and disability in elderly patients with major depression. Am J Geriatr Psychiatry 2001; 9: 269–74

    PubMed  CAS  Google Scholar 

  137. Sinclair P, Lyness J, King D, Cox C, Caine E. Depression and self-reported functional status in older primary care patients. Am J Psychiatr 2001; 158: 416–9.

    Article  PubMed  CAS  Google Scholar 

  138. Cole MG, Dendukuri N. Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. Am J Psychiatry 2003; 160: 1147–56.

    Article  PubMed  Google Scholar 

  139. Wulsin LR, Vaillant GE, Wells VE. A systematic review of the mortality of depression. Psychosom Med 1999; 61: 6–17.

    PubMed  CAS  Google Scholar 

  140. Schulz R, Drayer RA, Rollman BL. Depression as a risk factor for non-suicide mortality in the elderly. Biol Psychiatry 2002; 52: 205–25.

    Article  PubMed  Google Scholar 

  141. Cuijpers P, Smith F. Excess mortality in depression: a metaanalysis of community studies. J Affect Disord 2002; 72: 227–36.

    Article  PubMed  Google Scholar 

  142. Irwin M, Patterson T, Smith TL, et al. Reduction of immune function in life stress and depression. Biol Psychiatry 1990; 27: 22–30.

    Article  PubMed  CAS  Google Scholar 

  143. Ladwig KH, Kieser M, Konig J, Breithardt G, Borggrefe M. Affective disorders and survival after acute myocardial infarction. Results from the post-infarction late potential study. Eur Heart J 1991; 12: 959–64.

    CAS  Google Scholar 

  144. Lesperance F, Frasure-Smith N, Talajic M. Major depression before and after myocardial infarction: its nature and consequences. Psychosom Med 1996; 58: 99–110.

    PubMed  CAS  Google Scholar 

  145. Herrmann-Lingen C, Klemme H, Meyer T. Depressed mood, physician-rated prognosis, and comorbidity as independent predictors of 1-year mortality in consecutive medical inpatients. J Psychosom Res 2001; 50: 295–301.

    Article  PubMed  CAS  Google Scholar 

  146. Mehta KM, Yaffe K, Langa KM, Sands L, Whooley MA, Covin-sky KE. Additive effects of cognitive function and depressive symptoms on mortality in elderly community-living adults. J Gerontol 2003; 58: M461–7.

    Article  Google Scholar 

  147. Abas M, Hotopf M, Prince M. Depression and mortality in a highrisk population. 11-Year follow-up of the Medical Research Council Elderly Hypertension Trial. Br J Psychiatry 2002; 181: 123–8.

    Google Scholar 

  148. Conwell Y, Lyness JM, Duberstein P, et al. Completed suicide among older patients in primary care practices: a controlled study. J Am Geriatr Soc 2000; 48: 23–9.

    PubMed  CAS  Google Scholar 

  149. Conwell Y, Duberstein PR, Cox C, Herrmann JH, Forbes NT, Caine ED. Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. Am J Psychiatry 1996; 153: 1001–8.

    PubMed  CAS  Google Scholar 

  150. Conner KR, Duberstein PR, Conwell Y. The validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. I. Psychiatric diagnoses. Acta Psychiatr Scand 2001; 104: 204–9.

    Article  CAS  Google Scholar 

  151. Beautrais AL. A case control study of suicide and attempted suicide in older adults. Suicide Life Threat Behav 2002; 32: 1–9.

    Article  PubMed  Google Scholar 

  152. Rihmer Z, Rutz W, Pihlgren H. Depression and suicide in Gotland. An intensive study of all suicides before and after a depression-training programme for general practitioners. J Affect Disord 1995; 35: 147–52.

    CAS  Google Scholar 

  153. Pearson JL, Brown GK. Suicide prevention in late life: directions for science and practice. Clin Psychol Rev 2000; 20: 685–705.

    Article  PubMed  CAS  Google Scholar 

  154. Montano CB. Primary care issues related to the treatment of depression in elderly patients. J Clin Psychiatry 1999; 60 (Suppl 20): 45–51.

    Article  PubMed  Google Scholar 

  155. Montgomery SA, Beekman ATF, Sadovoy J, Salzman C, Thomson C, Zisook S. Consensum statement on depression in the elderly. J Clin Psychiatry 2000; 2: 46–52.

    Google Scholar 

  156. Flint AJ, Rifat SL. Mainteinance treatment for recurrent depression in late life: a comparison of pharmacotherapy and ECT. Am J Geriatr Psychiatry 1998; 13: 23–8.

    Article  CAS  Google Scholar 

  157. Lebowitz BD, Pearson JL, Schneider LS, et al. Diagnosis and treatment of depression in late life. Consensus statement update. JAMA 1997; 278: 1186–90.

    CAS  Google Scholar 

  158. NIH consensus conference. Diagnosis and treatment of depression in late life. JAMA 1992; 268: 1018–24.

    Article  Google Scholar 

  159. Alexopoulos GS. Depression and other mood disorders. Clin Geriatr 2000; 8: 69–82.

    Google Scholar 

  160. Gildengers AG, Houck PR, Mulsant BH, et al. Course and rate of antidepressant response in the very old. J Affect Disord 2002; 69: 177–84.

    Article  PubMed  Google Scholar 

  161. Salzman C, Wong E, Wright BC. Drug and ECT treatment of depression in the elderly, 1996–2001: a literature review. Biol Psychiatry 2002; 52: 265–84.

    Article  PubMed  Google Scholar 

  162. Mittmann N, Herrmann N, Einarson TR, et al. The efficacy, safety and tolerability of antidepressants in late life depression: a meta-analysis. J Affect Disord 1997; 46: 191–217.

    Article  PubMed  CAS  Google Scholar 

  163. Bondareff W, Alpert M, Friedhoff AJ, Richter EM, Clary CM, Batzar E. Comparison of sertraline and nortriptyline in the treatment of major depressive disorder in late life. Am J Psychiatry 2000; 157: 729–36.

    Article  PubMed  CAS  Google Scholar 

  164. Mulsant BH, Pollock BG, Nebes R, et al. A twelve-week, double-blind, randomized comparison of nortriptyline and paroxetine in older depressed inpatients and outpatients. Am J Geriatr Psychiatry 2001; 9: 406–14.

    PubMed  CAS  Google Scholar 

  165. MacGillivray S, Arroll B, Hatcher S, et al. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. BMJ 2003; 326: 1014.

    Article  PubMed  CAS  Google Scholar 

  166. Montgomery SA. Late-life depression: rationalizing pharmacological treatment options. Gerontology 2002; 48: 392–400.

    Article  PubMed  Google Scholar 

  167. Salzman C. Practical considerations for the treatment of depression in elderly and very elderly long-term care patients. J Clin Psychiatry 1999; 60 (Suppl 20): 30–3.

    PubMed  Google Scholar 

  168. Glassman AH, Bigger JT Jr. Cardiovascular effects of therapeutic doses of tricyclic antidepressants. A review. Arch Gen Psychiatry 1981; 38: 815–20.

    Article  PubMed  CAS  Google Scholar 

  169. DeVane CL. Pharmacokinetics of the newer antidepressants: clinical relevance. Am J Med 1994; 97: S13–23.

    Article  Google Scholar 

  170. Feighner JP, Cohn JB. Double-blind comparative trials of fluoxetine and doxepin in geriatric patients with major depressive disorder. J Clin Psychiatry 1985; 46: 20–5.

    PubMed  CAS  Google Scholar 

  171. Cohn CK, Shrivastava R, Mendels J, et al. Double-blind, multicenter comparison of sertraline and amitriptyline in elderly depressed patients. J Clin Psychiatry 1990; 51 (Suppl B): 28–33.

    PubMed  Google Scholar 

  172. Katona CL, Hunter BN, Bray J. A double-blind comparison of the efficacy and safety of paroxetine and imipramine in the treatment of depression with dementia. Int J Geriatr Psychiatry 1998; 13: 100–8.

    Article  PubMed  CAS  Google Scholar 

  173. Nyth AL, Gottfries CG, Lyby K, et al. A controlled multicenter clinical study of citalopram and placebo in elderly depressed patients with and without concomitant dementia. Acta Psychiatr Scand 1992; 86: 138–45.

    Article  PubMed  CAS  Google Scholar 

  174. Rahman MK, Akhtar MJ, Savla NC, Sharma RR, Kellett JM, Ashford JJ. A double-blind, randomised comparison of fluvoxamine with dothiepin in the treatment of depression in elderly patients. Br J Clin Pract 1991; 45: 255–8.

    PubMed  CAS  Google Scholar 

  175. Kirby D, Harrigan S, Ames D. Hyponatraemia in elderly psychiatric patients treated with Selective Serotonin Reuptake Inhibitors and venlafaxine: a retrospective controlled study in an inpatient unit. Int J Geriatr Psychiatry 2002; 17: 231–7.

    Article  PubMed  Google Scholar 

  176. Kirby D, Ames D. Hyponatraemia and selective serotonin re-uptake inhibitors in elderly patients. Int J Geriatr Psychiatry 2001; 16: 484–93.

    Article  PubMed  CAS  Google Scholar 

  177. Thapa PB, Gideon P, Cost TW, Milam AB, Ray WA. Antide-pressants and the risk of falls among nursing home residents. N Engl J Med 1998; 339: 875–82.

    Article  PubMed  CAS  Google Scholar 

  178. Gillman PK. The serotonin syndrome and its treatment. J Psychopharmacol 1999; 13: 100–9.

    Article  PubMed  CAS  Google Scholar 

  179. de Abajo FJ, Rodriguez LA, Montero D. Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case-control study. BMJ 1999; 319: 1106–9.

    Article  PubMed  Google Scholar 

  180. Barbey JT, Roose SP. SSRI safety in overdose. J Clin Psychiatry 1998; 59 (Suppl 15): 42–8.

    PubMed  CAS  Google Scholar 

  181. Alexopoulos G, Katz I, Reynolds C, Carpenter D, Docherty J. The Expert Consensus Guideline Series: pharmacotherapy of depressive disorders in older patients. Postgrad Med 2001: 1–86.

    Google Scholar 

  182. Mahapatra SN, Hackett D. A randomised, double-blind, parallel-group comparison of venlafaxine and dothiepin in geriatric patients with major depression. Int J Clin Pract 1997; 51: 209–13.

    PubMed  CAS  Google Scholar 

  183. Hoyberg OJ, Maragakis B, Mullin J, et al. A double-blind multicentre comparison of mirtazapine and amitriptyline in elderly depressed patients. Acta Psychiatr Scand 1996; 93: 184–90.

    Article  PubMed  CAS  Google Scholar 

  184. Schatzberg AF, Kremer C, Rodrigues HE, Murphy GM Jr. Mirtazapine vs. Paroxetine Study Group. Double-blind, randomized comparison of mirtazapine and paroxetine in elderly depressed patients. Am J Geriatr Psychiatry 2002; 10: 541–50.

    PubMed  Google Scholar 

  185. Berzewski H, Van Moffaert M, Gagiano CA. Efficacy and tolerability of reboxetine compared with imipramine in a double-blind study in patients suffering from major depressive episodes. Eur Neuropsychopharmacol 1997; 7 (Suppl 1): S37–47.

    Article  PubMed  CAS  Google Scholar 

  186. Katona C, Bercoff E, Chiu E, Tack P, Versiani M, Woelk H. Reboxetine versus imipramine in the treatment of elderly patients with depressive disorders: a double-blind randomised trial. J Affect Disord 1999; 55: 203–13.

    Article  PubMed  CAS  Google Scholar 

  187. Weihs KL, Settle EC Jr, Batey SR, Houser TL, Donahue RM, Ascher JA. Bupropion sustained release versus paroxetine for the treatment of depression in the elderly. J Clin Psychiatry 2000; 61: 196–202.

    Article  PubMed  CAS  Google Scholar 

  188. Amore M, Ricci M, Zanardi R, Perez J, Ferrari G. Long-term treatment of geropsychiatric depressed patients with venlafaxine. J Affect Disord 1997; 46: 293–6.

    Article  PubMed  CAS  Google Scholar 

  189. Thase ME. Effects of venlafaxine on blood pressure: a meta-analysis of original data from 3744 depressed patients. J Clin Psychiatry 1998; 59: 502–8.

    Article  PubMed  CAS  Google Scholar 

  190. Mueller TI, Leon AC, Keller MB, et al. Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry 1999; 156: 1000–6.

    PubMed  CAS  Google Scholar 

  191. Remick RA. Diagnosis and management of depression in primary care: a clinical update and review. CMAJ 2002; 167: 1253–60.

    PubMed  Google Scholar 

  192. Rothschild AJ. Challenges in the treatment of depression with psychotic features. Biol Psychiatry 2003; 53: 680–90.

    Article  PubMed  Google Scholar 

  193. Gregor KJ, Riley JA, Downing DK. Concomitant use of anxiolytics and hypnotics with selective serotonin reuptake inhibitors. Clin Ther 1996; 18: 521–7.

    Article  PubMed  CAS  Google Scholar 

  194. Pathiyal A, Hylan TR, Jones JK, Davtian D, Sverdlov L, Keyser M. Prescribing of selective serotonin reuptake inhibitors, anxiolytics, and sedative-hypnotics by general practitioners in The Netherlands: a multivariate analysis. Clin Ther 1997; 19: 798–810.

    Article  PubMed  CAS  Google Scholar 

  195. Joffe RT, Levitt AJ, Sokolov ST. Augmentation strategies: focus on anxiolytics. J Clin Psychiatry 1996; 57 (Suppl 7): 25–31.

    PubMed  Google Scholar 

  196. Godber C, Rosenvinge H, Wilkinson D, Smithes J. Depression in old age: prognosis after ECT. Intl J Geriatr Psychiatr 1987; 2: 19–24.

    Article  Google Scholar 

  197. Kelly KG, Zisselman M. Update on electroconvulsive therapy (ECT) in older adults. J Am Geriatr Soc 2000; 48: 560–6.

    PubMed  CAS  Google Scholar 

  198. McNamara B, Ray JL, Arthurs OJ, Boniface S. Transcranial magnetic stimulation for depression and other psychiatric disorders. Psychol Med 2001; 31: 1141–6.

    Article  PubMed  CAS  Google Scholar 

  199. Dannon PN, Dolberg OT, Schreiber S, Grunhaus L. Three and six-month outcome following courses of either ECT or rTMS in a population of severely depressed individuals-preliminary report. Biol Psychiatry 2002; 51: 687–90.

    Article  PubMed  Google Scholar 

  200. Lebowitz BD, Pearson JL, Schneider LS, et al. Diagnosis and treatment of depression in late life. Consensus statement update. JAMA 1997; 278: 1186–90.

    CAS  Google Scholar 

  201. Gatz M, Fiske A, Fox LS, Kaskie B, Kasl-Godley JE, McCallum TJ. Empirically validated psychological treatments for older adults. J Ment Health Aging 1998; 4: 9–46.

    Google Scholar 

  202. Karel MJ, Hinrichsen G. Treatment of depression in late life: psychotherapeutic interventions. Clin Psychol Rev 2000; 20: 707–29.

    Article  PubMed  CAS  Google Scholar 

  203. Anderson DN. Treating depression in old age: the reasons to be positive. Age Ageing 2001; 30: 13–7.

    Article  PubMed  CAS  Google Scholar 

  204. Arean PA, Cook BL. Psychotherapy and combined psychotherapy/pharmacotherapy for late life depression. Biol Psychiatry 2002; 52: 293–303.

    Article  PubMed  Google Scholar 

  205. Niederehe G. Psychosocial treatments with depressed older adults: a research update. Am J Geriatr Psychiatry 1996; 4 (Suppl 1): S66–78.

    Google Scholar 

  206. Reynolds CF 3rd, Miller MD, Pasternak RE, et al. Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. Am J Psychiatry 1999; 156: 202–8.

    PubMed  Google Scholar 

  207. Thompson LW, Coon DW, Gallagher-Thompson D, Sommer BR, Koin D. Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. Am J Geriatr Psychiatry 2001; 9: 225–40.

    PubMed  CAS  Google Scholar 

  208. Lenze EJ, Dew MA, Mazumdar S, et al. Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: effects on social adjustment. Am J Psychiatry 2002; 159: 466–8.

    Article  PubMed  Google Scholar 

  209. Reynolds CF 3rd, Frank E, Perel JM, et al. Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. JAMA 1999; 281: 39–45.

    Article  PubMed  CAS  Google Scholar 

  210. Paykel ES, Scott J, Teasdale JD, et al. Prevention of relapse in residual depression by cognitive therapy: a controlled trial. Arch Gen Psychiatry 1999; 56: 829–35

    Article  PubMed  CAS  Google Scholar 

  211. Scott J, Teasdale JD, Paykel ES, et al. Effects of cognitive therapy on psychological symptoms and social functioning in residual depression. Br J Psychiatry 2000; 177: 440–6.

    Article  PubMed  CAS  Google Scholar 

  212. Browne G, Steiner M, Roberts J, et al. Sertraline and/or inter-personal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs. J Affect Disord 2002; 68: 317–30.

    Article  PubMed  Google Scholar 

  213. Floyd M. Bibliotherapy as an adjunct to psychotherapy for depression in older adults. J Clin Psychol 2003; 59: 187–95.

    Article  PubMed  Google Scholar 

  214. King AC, Rejeski WJ, Buchner DM. Physical activity interventions targeting older adults. A critical review and recommendations. Am J Prev Med 1998; 15: 316–33.

    Article  PubMed  CAS  Google Scholar 

  215. Dunn AL, Trivedi MH, O’Neal HA. Physical activity dose-response effects on outcomes of depression and anxiety. Med Sci Sports Exerc 2001; 33 (Suppl 6): S587–97.

    Article  PubMed  CAS  Google Scholar 

  216. Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of progressive resistance training in depressed elders. J Gerontol. 1997; 52: M27–35.

    CAS  Google Scholar 

  217. Blumenthal JA, Babyak MA, Moore KA, et al. Effects of exercise training on older patients with major depression. Arch Intern Med 1999; 159: 2349–56.

    Article  PubMed  CAS  Google Scholar 

  218. Mather AS, Rodriguez C, Guthrie MF, McHarg AM, Reid IC, Mc-Murdo ME. Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder: randomised controlled trial. Br J Psychiatry 2002; 180: 411–5.

    Article  PubMed  Google Scholar 

  219. Singh NA, Clements KM, Singh MA. The efficacy of exercise as a long-term antidepressant in elderly subjects: a randomized, controlled trial. J Gerontol 2001; 56: M497–504.

    Article  CAS  Google Scholar 

  220. Penninx BW, Rejeski WJ, Pandya J, et al. Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Gerontol 2002; 57: P124–32.

    Article  Google Scholar 

  221. Dulac S, Brisson GR, Proteau L, Peronnet F, Ledoux M, De Carufel D. Selected hormonal response to repeated short bouts of anaerobic exercise. Med Sci Sport Exercise 1982; 14: 173–7.

    Google Scholar 

  222. Biddle SJ, Fox KR. Exercise and health psychology: emerging relationships. Br J Med Psychol 1989; 62: 205–16.

    Article  PubMed  Google Scholar 

  223. Farmer ME, Locke BZ, Moscicki EK, Dannenberg AL, Larson DB, Radloff LS. Physical activity and depressive symptoms: the NHANES I Epidemiologic Follow-up Study. Am J Epidemiol 1988; 128: 1340–51.

    PubMed  CAS  Google Scholar 

  224. Camacho TC, Roberts RE, Lazarus NB, Kaplan GA, Cohen RD. Physical activity and depression: evidence from the Alameda County Study. Am J Epidemiol 1991; 134: 220–31.

    PubMed  CAS  Google Scholar 

  225. Blumenthal JA, Hart A, Sherwood A, et al. Depression and vascular function in older adults. Evaluating the benefits of exercise in a new study at Duke University. NC Med J 2001; 62: 95–8.

    CAS  Google Scholar 

  226. Skelton DA. Effects of physical activity on postural stability. Age Ageing 2001; 30 (Suppl 4): 33–9.

    Article  PubMed  Google Scholar 

  227. Penninx BW, Messier SP, Rejeski WJ, et al. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Arch Intern Med 2001; 161: 2309–16.

    Article  PubMed  CAS  Google Scholar 

  228. Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 2002; 347: 1068–74.

    Article  PubMed  Google Scholar 

  229. Sabin EP. Social relationships and mortality among the elderly. J Appl Gentol 1993;12: 44–60.

    Article  Google Scholar 

  230. Russell DW, Cutrona CE. Social support, stress, and depressive symptoms among the elderly: test of a process model. Psychol Aging 1991; 6: 190–201.

    Article  PubMed  CAS  Google Scholar 

  231. Hashimoto K, Kurita H, Haratani T, Fujii K, Ishibashi T. Direct and buffering effects of social support on depressive symptoms of the elderly with home help. Psychiatry Clin Neurosci 1999; 53: 95–100.

    Article  PubMed  CAS  Google Scholar 

  232. Blixen CE, Kippes C. Depression, social support, and quality of life in older adults with osteoarthritis. Image J Nurs Sch 1999; 31: 221–6.

    Article  PubMed  CAS  Google Scholar 

  233. Jane-Llopis E, Hosman C, Jenkins R, Anderson P. Predictors of efficacy in depression prevention programmes. Meta-analysis. Br J Psychiatry 2003; 183: 384–97.

    Article  PubMed  Google Scholar 

  234. Bird MJ, Parslow RA. Potential for community programs to prevent depression in older people. Med J Aust 2002; 177 (Suppl): S107–10.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia, Via Brunamonti 51, 06122, Perugia, Italy

    Patrizia Mecocci MD, PhD, Antonio Cherubini, Elena Mariani, Carmelinda Ruggiero & Umberto Senin

Authors
  1. Patrizia Mecocci MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Cherubini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elena Mariani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carmelinda Ruggiero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Umberto Senin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrizia Mecocci MD, PhD.

Additional information

Equal contribution.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mecocci, P., Cherubini, A., Mariani, E. et al. Depression in the elderly: new concepts and therapeutic approaches. Aging Clin Exp Res 16, 176–189 (2004). https://doi.org/10.1007/BF03327382

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03327382

Key Words

Search

Navigation