Depression in older people

Abstract

Depression remains common in older people. It is strongly associated with physical illnesses and with cognitive impairment and has a complex set of relationships with dementia. Its aetiology involves a complex interplay of physical and psychosocial risk and protective factors. Its neurobiology includes a strong relationship with vascular diseases, neuroendocrine abnormalities, an increase in MRI white matter hyperintense lesions, a reduction in volume of the hippocampus and frontal and subcortical structures, and neuronal abnormalities in such structures. Management involves physical (mainly drugs but also ECT) and psychological treatments. In the acute phase, remission is the aim, and following this, continuation and maintenance stages should continue with the same treatments indefinitely. Prognosis overall is not as good as in younger adults, but this is largely due to the presence of cognitive deficits and physical ill health.