Depressive Disorders

Depressive disorders are fairly common among older adults. These disorders can cause significant morbidity and mortality among older people. Unfortunately, depressive disorders are often misdiagnosed or underdiagnosed in this population. A detailed history, a comprehensive mental status examination, a focused physical examination, screening laboratory studies, and appropriate use of neuropsychological testing can assist with the diagnosis of depression among older adults. Available data indicates that both psychotherapy and pharmacotherapy are beneficial in the treatment of depression among older individuals. Electroconvulsive therapy (ECT) is highly effective in the treatment of depressive disorders with psychotic features, catatonic features, and agitation and among individuals who are refractory to other treatments and in situations where there is urgent need for treatment response either due to suicidal or homicidal behaviors or failure to thrive. Evidence also indicates benefits of ketamine, repetitive transcranial magnetic stimulation (rTMS), and collaborative care approaches for the treatment of depression among older adults.