Managing depression and anxiety in the elderly patient

Depression in the elderly is under-recognised and under-treated, even more than in younger patients. Late-life depression is a chronic and disabling illness, but there is a common misconception that it is a normal feature of ageing. It can also be difficult to differentiate depression from coexisting anxiety and cognitive disorders. Antidepressants are as effective in acute treatment in older, as in younger, depressed adults. Maintenance antidepressant therapy also appears as effective in older patients. It may, however, be difficult to attain therapeutic levels of tricylic antidepressants (TCAs) in the elderly because of side effects. The selective serotonin re-uptake inhibitors (SSRIs) have more favourable safety and tolerability profiles, making them a suitable treatment option for older patients, who are more vulnerable to adverse effects. In selecting an SSRI for treating late-lift: depression, its pharmacokinetic profile and effects on coexisting illnesses that are prevalent in the elderly, such as anxiety, dementia and cardiovascular disease, also need to be considered. (C) 2000 Elsevier Science B.V. All rights reserved.