Evidence-based pharmacologic interventions for geriatric depression

Late-life depression is under-recognized and undertreated in older adults. Depressed older adults who are at an increased risk or undertreatment include patients older than 85 years, those with comorbid medical conditions, and older adults with cognitive impairment receiving home health care or living in nursing homes. Although the existing empirical treatment literature is limited, the available published treatment studies and expert consensus recommendations find that antidepressants are effective. In general the SSRIs and SNRIs pose a low risk for the most serious side effects. Treatment of psychotic depression has not been adequately investigated in older adults, although common practice includes treatment with an SSRI or SNRI in conjunction with an atypical antipsychotic. Treating with antidepressants augmented by psychotherapy can minimize relapse and disability in depressed patients. Continuation and maintenance treatment at an adequate dose and for an adequate length of time is critical in minimizing relapse. Empirical trials are needed that evaluate the selection and effectiveness of pharmacologic combination therapy and other treatment strategies for treatment resistant and partially responsive major depressive disorder in older adults.