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Treatment Considerations for Depression in the Elderly

  • David L. Dunner


While an episode of depression can first present in late life, it is more likely to be a recurrence of a disorder that began earlier in life or a continuation of a chronic form of depression. Depression in the elderly often occurs in the context of ongoing medical conditions. The treatment for these medical conditions may pose problems in treatment of depression due to increased likelihood of drug interactions. This article discusses pharmacotherapeutic and psychotherapeutic approaches to the treatment of depression in the elderly population.


Corresponding author

Please direct all correspondence to: David L. Dunner, MD, FACP, Department of Psychiatry and Behavioral Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 306C, Seattle, WA 98105; Tel: 206-543-6768; Fax:, 206-543-7565; E-mail:


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1.Alexopoulos, GS, Katz, IR, Reynolds, CF III, et al.The expert consensus guideline series: pharmacotherapy of depressive disorders in older patients. Postgrad Med. October 2001:186. Special Report.
2.Krishnan, KRR, Hays, JC, Tupler, LA, et al.Clinical and phenomenological comparisons of late-onset and early-onset depression. Am J Psychiatry. 1995;152:785788.
3.Steffens, DC, Skoog, I, Norton, MC, et al.Prevalence of depression and its treatment in an elderly population: the Cache County Study. Arch Gen Psychiatry. 2000;57:601607.
4.Luber, MP, Meyers, BS, Williams-Russo, PG, et al.Depression and service utilization in elderly primary care patients. Am J Geriatr Psychiatry. 2001;9:169176.
5.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
6.Lenze, EJ. Comorbidity of depression and anxiety in the elderly. Curr Psychiatry Rep. 2003;5:6267.
7.Alexopoulos, GS, Borson, S, Cuthbert, BM, et al.Assessment of late life depression. Biol Psychiatry. 2002;52;164174.
8.Conwell, Y, Duberstein, PR, Caine, ED. Risk factors for suicide in late life. Biol Psychiatry. 2002;52:193204.
9.Hirschfeld, RMA, Russell, JM. Assessment and treatment of suicidal patients. N Eng J Med. 1997;337:910915.
10.Szanto, K, Mulsant, BH, Houck, P, et al.Occurrence and course of suicidality during short-term treatment of late-life depression. Arch Gen Psychiatry. 2003;60:610617.
11.Krishnan, KRR. Biological risk factors in late depression. Biol Psychiatry. 2002;52:185192.
12.Whyte, EM, Mulsant, BH. Post stroke depression: epidemiology, psychopathology, and biological treatment. Biol Psychiatry. 2002;52:253264.
13.Devanand, DP. Comorbid psychiatric disorders in late life depression. Biol Psychiatry. 2002;52:236242.
14.Krishnan, KR, Hays, JC, Blazer, DG. MRI-defined vascular depression. Am J Psychiatry. 1997;154:497501.
15.Robinson, RG, Schultz, SK, Castillo, C, et al.Nortriptyline versus fluoxetine in the treatment of depression and in short term recovery after stroke: a placebo-controlled, double-blind study. Am J Psychiatry. 2000;157:351359.
16.Alexopoulos, GS, Kiosses, DN, Choi, SJ, et al.Frontal white matter microstructure and treatment response of late-life depression: a preliminary study. Am J Psychiatry. 2002;159:19291932.
17.Miller, MD, Lenze, EJ, Dew, MA, et al.Effect of cerebrovascular risk factors in depression treatment outcome in later life. Am J Psychiatry. 2002;10:592598.
18.Salloway, S, Boyle, PA, Correia, S, et al.The relationship of MRI subcortical hyperintensities to treatment response in a trial of sertraline in geriatric depressed out-patients. Am J Psychiatry. 2002;10:107111.
19.Bruce, ML. Psychosocial risk factors for depressive disorders in late life. Biol Psychiatry. 2002;52:175184.
20.Arean, PA, Cook, BL. Psychotherapy and combined psychotherapy/pharmacology for late life depression. Biol Psychiatry. 2002;52:293303.
21.Gallagher-Thompson, D, Hanley-Peterson, P, Thompson, LW. Maintenance of gains versus relapse following brief psychotherapy for depression. J Consult Clin Psychol. 1990;58:371374.
22.Reynolds, CF III, 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;281:3945.
23.Lenze, EJ, Dew, MA, Mazumdar, S, et al.Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: effects of social adjustment. Am J Psychiatry. 2002;159:466468.
24.Unützer, J, Katon, W, Callahan, CM, et al.Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288:28362845.
25.Salzman, C, Wong, E, Wright, BC. Drug and ECT treatment of depression in the elderly, 1996-2001: a literature review. Biol Psychiatry. 2002;52:265284.
26.Kirby, D, Harrigan, S, Ames, D. Hyponatremia in elderly psychiatric patients treated with selective serotonin reuptake inhibitors and venlafaxine: a retrospective controlled study in an inpatient unit. Int J Geriatric Psychiatry. 2002;17:231237.
27.Heiligenstein, JH, Ware, JE, Buesterien, KM, et al.Acute effects of fluoxetine versus placebo on functional health and well-being in late-life depression. Int Psychogeriatr. 1995;7(suppl):125137.
28.Small, GW, Hamilton, SH, Bystritsky, A, et al.Clinical response predictors in a double-blind, placebo-controlled trial of fluoxetine for geriatric major depression. Fluoxetine Collaborative Study Group. Int Psychogeriatr. 1995;7(suppl):4153.
29.Koran, LM, Hamilton, SH, Hertzman, M, et al.Predicting response to fluoxetine in geriatric patients with major depression. J Clin Psychopharmacol. 1995;15:421427.
30.Arranz, FJ, Ros, S. Effects of comorbidity and polypharmacy in the clinical usefulness of sertraline in elderly depressed patients: an open multicenter study. J Affect Disor. 1997;46:285291.
31.Schneider, LS, Nelson, JC, Clary, CM, et al.An 8-week multicenter, parallel group, double-blind, placebo-controlled study of sertraline in elderly patients with major depression. Am J Psychiatry. 2003;160:12771285.
32.Bump, GM, Mulsant, BH, Pollock, MG, et al.Paroxetine versus nortriptyline in the continuation and maintenance treatment of depression in the elderly. Depress Anxiety. 2001;13:3844.
33.Mulsant, BH, Pollock, BG, Nebes, RD, et al.A double-blind randomized comparison of nortriptyline and paroxetine in the treatment of late-life depression: 6 week outcome. J Clin Psychiatry. 1999;60(suppl 20):1620.
34.Dunner, DL, Cohn, JB, Walshe, T III, et al.Two combined, multicenter double-blind studies of paroxetine and doxepin in geriatric patients with major depression. J Clin Psychiatry. 1992;53(suppl):5760.
35.Reynolds, CF III. Paroxetine treatment of depression of late life. Psychopharm Bull. 2003;37(suppl):123134.
36.Rapaport, MH, Schneider, LS, Dunner, DL, et al.Efficacy of controlled-release paroxetine in the treatment of late-life depression. J Clin Psychiatry. 2003;64:10651074.
37.Karlsson, I, Godderis, K, De Mendonca, A, Lima, C. A randomized, double-blind comparison of the efficacy and safety of citalopram combined with mianserin in elderly, depressed patients with or without mild to moderate dementia. Int J Clin Psychiatry. 2000;15:295305.
38.Kyle, CJ, Peterson, HEH, Overo, KF. Comparison of the tolerability and efficacy of citalopram and amitriptyline in elderly depressed patients treated in general practice. Depress Anxiety. 1998;8:147153.
39.Altamura, AC, Mauri, MC, Rudas, N, et al.Clinical activity and tolerability of trazodone, mianserin, and amitriptyline in elderly subjects with major depression: a controlled multicenter trial. Clin Neuropharmacol. 1989;12(suppl 1):S25S37.
40.Scher, M, Krieger, JN, Juergens, S. Trazodone and priapism. Am J Psychiatry. 1983;140:13621363.
41.Weihs, KL, Settle, EC Jr, Batey, SR, et al.Bupropion sustained release versus paroxetine for the treatment of depression in the elderly. J Clin Psychiatry. 2000;61:196202.
42.Steffens, DC, Doraiswamy, PM, McQuoid, DR. Bupropion SR in the naturalistic treatment of elderly patients with major depression. Int J Geriatr Psychiatry. 2001;16:862865.
43. Wellbutrin (package insert). Research Triangle Park, NC: GlaxoSmithKline; 2001.
44.Amore, M, Ricci, M, Zanardi, R, et al.Long-term treatment of geropsychiatric depressed patients with venlafaxine. J Affect Disord. 1997;46:293296.
45.Dierick, M. An open-label evaluation of the long-term safety of oral venlafaxine in depressed elderly patients. Ann Clin Psychiatry. 1996;8:169178.
46.Khan, A, Rudolph, R, Baumel, B, et al.Venlafaxine in depressed geriatric outpatients: an open-label clinical study. Psychopharm Bull. 1995;31:753758.
47.Mahaptra, SN. A randomized, double-blind, parallel group comparison of venlafaxine and dothiepin in geriatric patients with major depression. IJPC. 1997;51:209213.
48.Staab, JP, Evans, DL. Efficacy of venlafaxine in geriatric depression. Depress Anxiety. 2000;12(suppl 1):6368.
49.Goldberg, RJ. Antidepressant use in the elderly: current status of nefazodone, venlafaxine, and moclobemide. Drugs Aging. 1997;11:119131.
50.Thase, ME, Entsuah, AR, Rudolph, RL. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry. 2001;178:234241.
51.Keller, MB, McCullough, JP, Klein, DN, et al.A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. NEJM. 2000;342:14621470.
52.Dunner, DL, Laird, LK. Comparative safety and tolerability of nefazodone. J Clin Psychiatry. 2003;63(suppl 1):3336.
53.Hoyberg, OJ, Maragakis, B, Mullin, J, et al.A double-blind multicenter comparison of mirtazapine and amitriptyline in elderly depressed patients. Acta Psychiatr Scand. 1996;93:184190.
54.Schatzberg, AF, Kremer, C, Rodrigues, HE, et al.Double-blind, randomized comparison of mirtazapine and paroxetine in elderly depressed patients. Am J Geriatr Psychiatry. 2002;10:541550.
55.Abrams, R. Electroconvulsive Therapy. 4th ed. New York, NY: Oxford Press; 2002.
56.Small, JG, Kellams, JJ, Milstein, , et al.Complications with electroconvulsive treatment combined with lithium. Biol Psychiatry. 1980;15:103112.

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Treatment Considerations for Depression in the Elderly

  • David L. Dunner


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