ABSTRACT

The treatment of depression in older people invariably needs an integrated approach with pharmacological, social and psychological approaches working together. However, a brief discussion emphasises the importance of understanding the aetiology of depression as this can have important implications for treatment and prognosis. Treatment resistance is reported in up to 40% of older patients with major depression. There is little evidence to guide the management of depression that has failed to respond to a course of an antidepressant and further research is needed to inform clinical practice. A further Cochrane review of amitryptyline for older people found that it was at least as effective as other tricyclic antidepressants and newer compounds, especially selective serotonin reuptake inhibitors, but patients taking amitriptyline experienced a higher prevalence of side-effects. Older people need to be thoroughly assessed before commencing antidepressants due to the increased incidence of physical illnesses, changes in pharmacokinetics and increased sensitivity to side-effects.