Depressive Disorders

About one in three cases of depressive disorders in the geriatric population have their onset in late life; many more cases are recurrences of depressive disorders which began earlier in life. This chapter reviews the diagnosis and treatment of depressive disorders in late life to facilitate their differentiation from other conditions and recommend non-pharmacological treatment and age-adjusted pharmacological interventions. Both early-onset and late-onset categories may be unreported or missed. Late-life depressive disorders have been under-recognized and inadequately treated in primary care, especially among Hispanic and African American men in the United States (Hasin et al. JAMA Psychiatry 75:336–46, 2018)). Many factors may account for missed depressive disorders among aging individuals. The geriatric patient may present with more somatic complaints, greater social isolation, and reduced access to medical care (especially for underserved minority populations) and be hesitant to report depressive symptoms. The impact of psychosocial stressors on the patient may not be fully appreciated nor is clinical time often adequate to explore them. The number of systemic medical comorbidities increases with age and correlates with the increased prevalence of depressive disorders as patients age. Teasing out depressive symptoms among somatic complaints in the elderly patient is a challenge. Complex medication regimens, in the context of pharmacodynamic and pharmacokinetic effects of aging, can contribute to an increased risk of adverse effects, which can also contribute to depressive symptoms.