This week’s British Medical Journal features a review of depression in later life.

The authors bring together recent systematic reviews, meta-analyses, and randomised controlled trials to summarise best current knowledge about the diagnosis and management of patients who develop depression in later life.

The review addresses the following questions:

• What is late life depression and who gets it?
• How is depression diagnosed in older patients?
• Is depression more difficult to diagnose in older adults?
• Does depression increase the risk of dementia?
• How is late life depression managed?
• When should I refer?
• Which medication should be prescribed?
• What if first line drug treatment doesn’t work?
• Can older adults benefit from psychological therapy?
• What is the outlook for older adults with depression?

The summary from the review states:

Depression in older adults is associated with an increased risk of death and disability

Cognitive and functional impairment and anxiety are more common in older than in younger adults with depression

Older adults with depression are at increased risk of suicide and are more likely than younger adults to complete suicide

Depression is associated with cognitive impairment and an increased risk of dementia

A selective serotonin reuptake inhibitor should be the first line pharmacological treatment for depression for most older adults, including those with chronic physical illness

Psychological and drug treatment is as effective in older as in younger adults

Subthreshold depressive symptoms that substantially affect older patients’ lives are common and management with psychosocial and drug strategies may be effective and prevent further deterioration

Rodda, J. et al. Depression in older adults. BMJ 2011;343. [BMJ abstract]