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This limits the ability to generalize from these study findings when treating the elderly.Nonetheless, in recent years there is an increasing body of literature specific to the elderly (as referenced below), which helps guide the clinician in the appropriate prescription and use of antidepressants in this patient population.If remission is not achieved, then add-on treatments, including other drugs and psychotherapy, may be considered.In cases of severe, psychotic, or refractory depression in the elderly, electroconvulsive therapy is recommended.Depression is the most common mental health problem in the elderly and is associated with a significant burden of illness that affects patients, their families, and communities and takes an economic toll as well.Prevalence studies suggest that 14% to 20% of the elderly living in the community experience depressive symptoms, with higher rates among the elderly in hospital (12% to 45%) and even higher rates in long-term care facilities (an estimated 40%). Because of our aging population, it is expected that the number of seniors suffering from depression will increase.
• Review of psychiatric comorbid illnesses.• Review of medical illnesses.• Personal and family history of mood disorder, as well as other psychiatric illnesses.• Review of current medications and allergies.• Review of substance use.• Review of current stresses and life situation.• Level of functioning/disability.• Review of support system, family situation, and personal strengths.• Mental status examination, including an assessment of cognitive functioning.• Physical examination and laboratory investigations in order to identify any medical problems that could contribute to or mimic depressive symptoms (e.g., hypothyroidism and anemia, leading to TSH, B12, and Hb testing being part of the workup).• Review of collateral information when available.According to a Statistics Canada report in 2005, the suicide rate for elderly men is almost twice that of the nation as a whole.6 Effectively lethal self-harm behaviors increase with age, with the most common means of suicide in older men being firearms and hanging, and in older women being self-poisoning and hanging. Fortunately, depression in the elderly can be treated successfully.However, it is necessary first to identify and diagnose depression, which can be challenging in this population owing to communication difficulties caused by hearing or cognitive impairment, other comorbidities with physical symptoms similar to those of depression, and the stigma associated with mental illness that can limit the self-reporting of depressive symptoms.Tricyclic antidepressants are lethal in overdose and are avoided for this reason.Choice of antidepressant Fortunately there are several antidepressants that have been shown to be efficacious in elderly patients being treated for a major depressive episode without psychotic features.