title: Treatment of depression in older adults.
abstract: Depression is the most frequent mental disorder in older people, often causing emotional distress and reduced quality of life. Despite its clinical significance, depression remains underdiagnosed and inadequately treated in older patients. Regarding prognosis, data suggest that almost 70% of patients, treated long enough and with appropriate doses, recover from an index episode of depression. Antidepressants are efficient for treating depressed outpatients with several comorbid physical diseases as well as hospitalized patients, with selective serotonin reuptake inhibitors being the antidepressants of choice for older patients. Available data can guide pharmacological treatment in both the acute and maintenance stages, but further research is required to guide clinical strategies when remission is not achieved. Approaches for the management of resistance to treatment are summarized, including optimization strategies, drug changes, algorithms, and combined and augmentation pharmacological treatments. Finally, additional therapeutic choices such as electroconvulsive therapy, transcranial magnetic stimulation, and integrated psychotherapy are presented.
authors.affiliation: Old Age Research Group (PROTER), Institute of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP, Brazil. cbottino@usp.br
authors.forename: Cássio M C
authors.initials: CM
authors.lastname: Bottino
authors.forename: Ricardo
authors.initials: R
authors.lastname: Barcelos-Ferreira
authors.forename: Salma R I
authors.initials: SR
authors.lastname: Ribeiz
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000628:therapy*; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy / Q000379:methods; D006801:Humans; D011613:Psychotherapy / Q000379:methods*
chemical_list: D000928:Antidepressive Agents