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Chapter 15. Mood Disorders

Dan G. Blazer, M.D., Ph.D.; David C. Steffens, M.D., M.H.Sc.; Harold G. Koenig, M.D., M.H.Sc.
DOI: 10.1176/appi.books.9781585623754.391921

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Excerpt

Questions regarding depression in old age are frequently posed: Do persons become more depressed as they grow older? Does depression become more difficult to treat with increased age? Is depression more difficult to identify in the older adult? The answers to these questions rest in part with the definition of late-life depression. Depression in late life is not a unitary construct. Depending on how depression is defined, the answers to questions regarding late-life depression vary.

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Table Reference Number
Table 15–1. Subtypes of depression in later life
Table Reference Number
Table 15–2. Origins of late-life depression
Table Reference Number
Table 15–3. Diagnostic workup of late-life depression
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Table 15–4. Pharmacological treatment of late-life depression

References

Alexopoulos GS, Meyers BS, Young RC, et al: The course of geriatric depression with "reversible dementia": a controlled study. Am J Psychiatry 150:1693–1699, 1993
[PubMed]
 
Alexopoulos GS, Meyers BS, Young RC, et al: Recovery in geriatric depression. Arch Gen Psychiatry 53:305–312, 1996
[PubMed]
 
Ambelas A: Live events and mania. Br J Psychiatry 150:235–240, 1987
[PubMed]
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
 
Arborelius L, Owens M, Plotsky P, et al: The role of corticotropin-releasing factor in depression and anxiety disorders. J Endocrinol 160:1–12, 1999
[PubMed]
 
Arfken CL, Lichtenberg PA, Tancer ME: Cognitive impairment and depression predict mortality in medically ill older adults. J Gerontol A Biol Sci Med Sci 54:M152–M156, 1999
 
Atchley RC: A continuity theory of normal aging. Gerontologist 29:183–190, 1989
[PubMed]
 
Avery D, Lubrano A: Depression treated with imipramine and ECT: the DeCarolis study reconsidered. Am J Psychiatry 136:559–562, 1979
[PubMed]
 
Baldwin RC, Jolley DJ: The prognosis of depression in old age. Br J Psychiatry 149:574–583, 1986
[PubMed]
 
Baltes P, Staudinger U: Wisdom: a metaheuristic (pragmatic) to orchestrate mind and virtue toward excellence. Am Psychol 55:122–136, 2000
[PubMed]
 
Beck A: Cognitive model of depression. Journal of Cognitive Psychotherapy 1:2–27, 1987
 
Beekman A, Deeg D, van Tilberg T, et al: Major and minor depression in later life: a study of prevalence and risk factors. J Affect Disord 36:65–75, 1995
[PubMed]
 
Beekman AT, Deeg DJ, Geerlings SW, et al: Emergence and persistence of late life depression: a 3-year follow-up of the Longitudinal Aging Study Amsterdam. J Affect Disord 65:131–138, 2001
[PubMed]
 
Beekman A, Geerlings S, Deeg D, et al: The natural history of late-life depression. Arch Gen Psychiatry 59:605–611, 2002
[PubMed]
 
Black S: Increased health burden associated with comorbid depression in older diabetic Mexican Americans: results from the Hispanic Established Population for Epidemiologic Study of the Elderly survey. Diabetes Care 22:56–64, 1999
[PubMed]
 
Black S, Goodwin J, Markides K: The association between chronic diseases and depressive symptomology in older Mexican Americans. J Gerontol A Biol Sci Med Sci 53:M118–M194, 1998
 
Blazer DG: Social support and mortality in an elderly community population. Am J Epidemiol 115:684–694, 1982
[PubMed]
 
Blazer DG: Impact of late-life depression on the social network. Am J Psychiatry 140:162–166, 1983
[PubMed]
 
Blazer DG: Psychiatry and the oldest old. Am J Psychiatry 157:1915–1924, 2000
[PubMed]
 
Blazer DG: Depression in Late Life, 3rd Edition. New York, Springer, 2002
 
Blazer DG: Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci 58:249–265, 2003
[PubMed]
 
Blazer DG 2nd, Hybels CF: Origins of depression in later life. Psychol Med 35:1241–1252, 2005
[PubMed]
 
Blazer D, Bachar JR, Hughes DC: Major depression with melancholia: a comparison of middle-aged and elderly adults. J Am Geriatr Soc 35:927–932, 1987a
 
Blazer D, Hughes DC, George LK: The epidemiology of depression in an elderly community population. Gerontologist 27:281–287, 1987b
 
Blazer D, Hughes DC, Fowler N: Anxiety as an outcome symptom of depression in elderly and middle-aged adults. Int J Geriatr Psychiatry 4:273–278, 1989
 
Blazer D, Burchett B, Service C, et al: The association of age and depression among the elderly: an epidemiologic exploration. J Gerontol 46:M210–M215, 1991
 
Blazer DG, Hybels CF, Pieper CF: The association of depression and mortality in elderly persons: a case for multiple independent pathways. J Gerontol A Biol Sci Med Sci 56A:M505–M509, 2001
 
Blazer DG, Burchett B, Fillenbaum G: APOE 4 and low cholesterol as risks for depression in a biracial elderly community sample. Am J Geriatr Psychiatry 10:515–520, 2002a
 
Blazer DG, Moody-Ayers S, Craft-Morgan J, et al: Depression in diabetes and obesity: racial/ethnic/gender issues in older adults. J Psychosom Res 53:913–916, 2002b
 
Boyce P, Gilchrist J, Talley NJ, et al: Cognitive-behaviour therapy as a treatment for irritable bowel syndrome: a pilot study. Aust N Z J Psychiatry 34:300–309, 2000
[PubMed]
 
Braam AW, Beekman AT, Deeg DJ, et al: Religiosity as a protective or prognostic factor of depression in later life: results from a community survey in The Netherlands. Acta Psychiatr Scand 96:199–205, 1997a
 
Braam AW, Beekman AT, van Tilburg TG, et al: Religious involvement and depression in older Dutch citizens. Soc Psychiatry Psychiatr Epidemiol 32:284–291, 1997b
 
Breitbart W, Rosenfeld B, Pessin H, et al: Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 284:2907–2911, 2000
[PubMed]
 
Bridges P: The drug treatment of depression in old age, in Affective Disorders in the Elderly. Edited by Murphy E. Edinburgh, Scotland, Churchill Livingstone, 1986, pp 91–149
 
Brodaty H, Luscombe G, Parker G, et al: Early and late onset depression in old age: different aetiologies, same phenomenology. J Affect Disord 66:225–236, 2001
[PubMed]
 
Brown KW, Levy AR, Rosberger Z, et al: Psychological distress and cancer survival: a follow-up 10 years after diagnosis. Psychosom Med 65:636–643, 2003
[PubMed]
 
Bruce ML: Depression and disability in late life: directions for future research. Am J Geriatr Psychiatry 9:102–112, 2001
[PubMed]
 
Bruce ML: Psychosocial risk factors for depressive disorders in late life. Biol Psychiatry 52:175–184, 2002
[PubMed]
 
Bruce ML, Leaf PJ: Psychiatric disorders and 15-month mortality in a community sample of older adults. Am J Public Health 79:727–730, 1989
[PubMed]
 
Bukberg J, Penman D, Holland JC: Depression in hospitalized cancer patients. Psychosom Med 46:199–212, 1984
[PubMed]
 
Bump GM, Mulsant BH, Pollock BG, et al: Paroxetine versus nortriptyline in the continuation and maintenance treatment of depression in the elderly. Depress Anxiety 13:38–44, 2001
[PubMed]
 
Callahan CM, Nienaber NAS, Hendrie HC, et al: Depression of elderly outpatients: primary care physicians' attitudes and practice patterns. J Gen Intern Med 7:26–31, 1992
[PubMed]
 
Carstensen LL, Pasupathi M, Mayr U, et al: Emotional experience in everyday life across the adult life span. J Pers Soc Psychol 79:644–655, 2000
[PubMed]
 
Chi I, Chou KL: Social support and depression among elderly Chinese people in Hong Kong. Int J Aging Hum Dev 52:231–252, 2001
[PubMed]
 
Clayton PJ: Bereavement and depression. J Clin Psychiatry 51(suppl):34–40, 1990
 
Coffey CE, Hinkle PE, Weiner RD, et al: Electroconvulsive therapy of depression in patients with white matter hyperintensity. Biol Psychiatry 22:629–636, 1987
[PubMed]
 
Coffey CE, Figiel GS, Djang WT: Subcortical hyperintensity on magnetic resonance imaging: a comparison of normal and depressed elderly subjects. Am J Psychiatry 147:187–189, 1990
[PubMed]
 
Cohn CK, Shrivastava R, Mendels J, et al: Double-blind, multicenter comparison of sertraline and amitriptyline in elderly depressed patients. J Clin Psychiatry 51 (suppl B):28–33, 1990
 
Cole MG, Bellavance F, Mansour A: Prognosis of depression in elderly community and primary care populations: a systematic review and meta-analysis. Am J Psychiatry 156:1182–1189, 1999
[PubMed]
 
Cole MG, Elie LM, McCusker J, et al: Feasibility and effectiveness of treatments of post-stroke depression in elderly inpatients: systematic review. J Geriatr Psychiatry Neurol 14:37–41, 2001
[PubMed]
 
Cornoni-Huntley J, Blazer D, Lafferty M, et al (eds): Established Populations for Epidemiologic Studies of the Elderly: Resource Data Book, Vol 2. Bethesda, MD, National Institute on Aging, 1990
 
Covinsky KE, Kahana E, Chin MH, et al: Depressive symptoms and 3-year mortality in older hospitalized medical patients. Ann Intern Med 130:563–569, 1999
[PubMed]
 
Cutler NR, Post RM: Life course of illness in untreated manic-depressive patients. Compr Psychiatry 23:101–115, 1982
[PubMed]
 
Czéh B, Michaelis T, Watanabe T, et al: Stress-induced changes in cerebral metabolites, hippocampal volume, and cell proliferation are prevented by antidepressant treatment with tianeptine. Proc Natl Acad Sci U S A 98:12796–12801, 2001
[PubMed]
 
de Beurs E, Beekman A, Geerlings S, et al: On becoming depressed or anxious in late life: similar vulnerability factors but different effects of stressful life events. Br J Psychiatry 179:426–431, 2001
 
Devanand DP: Comorbid psychiatric disorders in late life depression. Biol Psychiatry 51:236–242, 2002
 
Devanand DP, Turret N, Moody BJ, et al: Personality disorders in elderly patients with dysthymic disorder. Am J Geriatr Psychiatry 8:188–195, 2000
[PubMed]
 
Devanand DP, Kim MK, Paykina N, et al: Adverse life events in elderly patients with major depression or dysthymia and in healthy-control subjects. Am J Geriatr Psychiatry 10:265–274, 2002
[PubMed]
 
Dunner DL: Affective disorder: clinical features, in Psychiatry, Vol 1. Edited by Michels R, Cavenar J. Philadelphia, JB Lippincott, 1985, pp 59–60
 
Eastham JH, Jeste DV, Young RC: Assessment and treatment of bipolar disorder in the elderly. Drugs Aging 12:205–224, 1998
[PubMed]
 
Eisses A, Kluiter H, Jongenelis K, et al: Risk indicators of depression in residential homes. Int J Geriatr Psychiatry 19:634–640, 2004
[PubMed]
 
Fassler LB, Gaviria M: Depression in the elderly. J Am Geriatr Soc 26:471–475, 1978
[PubMed]
 
Fillenbaum G: Multidimensional Functional Assessment of Older Adults: The Duke Older Americans Resources and Services Procedures. Hillsdale, NJ, Erlbaum, 1988
 
Fiske A, Gatz M, Pedersen NL: Depressive symptoms and aging: the effects of illness and non-health-related events. J Gerontol B Psychol Sci Soc Sci 58:P320–P328, 2003
 
Folstein M, Folstein S, McHugh P: "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198, 1975
[PubMed]
 
Frasure-Smith N, Lespérance F, Talajic M: Depression following myocardial infarction: impact on 6-month survival. JAMA 270:1819–1825, 1993 [Erratum in: JAMA 271(14):1082, 1994]
 
Fried L: Frailty, in Principles of Geriatric Medicine and Gerontology, 3rd Edition. Edited by Hazzard W, Bierman E, Blass J, et al. New York, McGraw-Hill, 1994, pp 1149–1156
 
Frith CD, Stevens M, Johnstone EC, et al: Effects of ECT and depression on various aspects of memory. Br J Psychiatry 142:610–617, 1983
[PubMed]
 
Gagné GG Jr, Furman MJ, Carpenter LL, et al: Efficacy of continuation ECT and antidepressant drugs compared to long-term antidepressants alone in depressed patients. Am J Psychiatry 157:1960–1965, 2000
[PubMed]
 
Gallagher DE, Thompson LW: Treatment of major depressive disorder in older outpatients with brief psychotherapies. Psychotherapy Theory, Research, Practice, Training 19:482–490, 1982
 
Gallo JJ, Rabins PV, Lyketsos CG: Depression without sadness: functional outcomes of nondysphoric depression in later life. J Am Geriatr Soc 45:570–578, 1997
[PubMed]
 
Gatz M, Pedersen N, Plomin R, et al: Importance of shared genes and shared environments for symptoms of depression in older adults. J Abnorm Psychol 101:701–708, 1992
[PubMed]
 
Geerlings SW, Beekman AT, Deeg DJ, et al: Duration and severity of depression predict mortality in older adults in the community. Psychol Med 32:609–618, 2002
[PubMed]
 
George LK, Blazer DG, Hughes DC, et al: Social support and the outcome of major depression. Br J Psychiatry 154:478–485, 1989
[PubMed]
 
George MS, Ketter TA, Post RM: Prefrontal cortex dysfunction in clinical depression. Depression 2:59–72, 1994
 
Glasser M, Rabins P: Mania in the elderly. Age Ageing 13:210–213, 1984
[PubMed]
 
Glassman AH, Shapiro PA: Depression and the course of coronary artery disease. Am J Psychiatry 155:4–11, 1998
[PubMed]
 
Gonzalez-Salvador MT, Arango C, Lyketsos CG, et al: The stress and psychological morbidity of the Alzheimer patient caregiver. Int J Geriatr Psychiatry 14:701–710, 1999
[PubMed]
 
Gorwood P, Weiller E, Lemming O, et al: Escitalopram prevents relapse in older adults with major depressive disorder. Am J Geriatr Psychiatry 15:581–593, 2007
[PubMed]
 
Gottfries CG: Neurochemical aspects on aging and diseases with cognitive impairment. J Neurosci Res 27:541–547, 1990
[PubMed]
 
Guttmann CR, Jolesz F, Kikinis R, et al: White matter changes with normal aging. Neurology 50:972–978, 1998
[PubMed]
 
Hays JC, Saunders WB, Flint EP, et al: Social support and depression as risk factors for loss of physical function in late life. Aging Mental Health 3:209–220, 1997
 
Hays JC, Steffens DC, Flint EP, et al: Does social support buffer functional decline in elderly patients with unipolar depression? Am J Psychiatry 158:1850–1855, 2001
[PubMed]
 
Heiligenstein JH, Ware JE Jr, Beusterien KM, et al: Acute effects of fluoxetine versus placebo on functional health and well-being in late-life depression. Int Psychogeriatr 7(suppl):125–137, 1995
 
Henderson AS, Jorm AF, MacKinnon A: The prevalence of depressive disorders and the distribution of depressive symptoms in later life: a survey using draft ICD-10 and DSM-III-R. Psychol Med 23:719–729, 1993
[PubMed]
 
Henderson AS, Korten AE, Jacomb PA, et al: The course of depression in the elderly: a longitudinal community-based study in Australia. Psychol Med 27:119–129, 1997
[PubMed]
 
Hickie I, Scott E, Naismith S, et al: Late-onset depression: genetic, vascular and clinical contributions. Psychol Med 31:1403–1412, 2001
[PubMed]
 
Hinkle P, Coffey CE, Weiner R, et al: ECT seizure duration varies with age. Paper presented at the American Geriatrics Society, Chicago, IL, 1986
 
Holahan CK, Holahan CJ: Self-efficacy, social support, and depression in aging: a longitudinal analysis. J Gerontol 42:65–68, 1987
[PubMed]
 
Holahan CJ, Moos RH: Social support and psychological distress: a longitudinal analysis. J Abnorm Psychol 90:365–370, 1981
[PubMed]
 
Hughes DC, Blazer DG, George LK: Age differences in life events: a multivariate controlled analysis. Int J Aging Hum Dev 127:207–220, 1988
 
Husain MM, McDonald WM, Doraiswamy PM, et al: A magnetic resonance imaging study of putamen nuclei in major depression. Psychiatry Res 40:95–99, 1991
[PubMed]
 
Hybels CF, Blazer DG, Pieper CF: Toward a threshold for subthreshold depression: an analysis of correlates of depression by severity of symptoms using data from an elderly community sample. Gerontologist 41:357–365, 2001
[PubMed]
 
Hybels CF, Pieper CF, Blazer DG: Sex differences in the relationship between subthreshold depression and mortality in a community sample of older adults. Am J Geriatr Psychiatry 10:283–291, 2002
[PubMed]
 
Hybels CF, Blazer DG, Steffens DC: Predictors of partial remission in older patients treated for major depression: the role of comorbid dysthymia. Am J Geriatr Psychiatry 13:713–721, 2005
[PubMed]
 
Idler EL: Religious involvement and the health of the elderly: some hypotheses and an initial test. Social Forces 66:226–238, 1987
 
Jang Y, Haley W, Small B: The role of mastery and social resources in the associations between disability and depression in later life. Gerontologist 42:807–813, 2002
[PubMed]
 
Keller MB, Shapiro RW, Lavori PW, et al: Recovery in major depressive disorder: analyses with the life table and regression models. Arch Gen Psychiatry 39:905–910, 1982a
 
Keller MB, Shapiro RW, Lavori PW, et al: Relapse in major depressive disorder: analysis with the life table. Arch Gen Psychiatry 39:911–915, 1982b
 
Kennedy GJ, Kelman HR, Thomas C: The emergence of depressive symptoms in late life: the importance of declining health and increasing disability. J Community Health 15:93–104, 1990
[PubMed]
 
Kessler RC, Chiu WT, Demler O, et al: Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627, 2005 [Erratum in: Arch Gen Psychiatry 62(7):709, 2005]
 
Klerman GL, Weissman MM, Rounsaville BJ, et al: Interpersonal Psychotherapy of Depression. New York, Basic Books, 1984
 
Koenig HG: Religion and depression in older medical inpatients. Am J Geriatr Psychiatry 15:282–291, 2007a
 
Koenig HG: Religion and remission of depression in medical inpatients with heart failure/pulmonary disease. J Nerv Ment Dis 195:389–395, 2007b
 
Koenig HG, Blazer DG: Epidemiology of geriatric affective disorders. Clin Geriatr Med 8:235–251, 1992
[PubMed]
 
Koenig HG, Meador KG, Cohen HJ, et al: Depression in elderly hospitalized patients with medical illness. Arch Intern Med 148:1929–1936, 1988
[PubMed]
 
Koenig HG, Goli V, Shelp F, et al: Antidepressant use in elderly medical inpatients: lessons from an attempted clinical trial. J Gen Intern Med 4:498–505, 1989a
 
Koenig HG, Shelp F, Goli V, et al: Survival and health care utilization in elderly medical inpatients with major depression. J Am Geriatr Soc 37:599–606, 1989b
 
Koenig HG, Cohen HJ, Blazer DG, et al: Religious coping and depression among elderly, hospitalized medically ill men. Am J Psychiatry 149:1693–1700, 1992
[PubMed]
 
Koenig HG, George LK, Peterson BL: Religiosity and remission of depression in medically ill older patients. Am J Psychiatry 155:536–542, 1998
[PubMed]
 
Koenig HG, George LK, Titus P: Religion, spirituality, and health in medically ill hospitalized older patients. J Am Geriatr Soc 52:554–562, 2004
[PubMed]
 
Kohn CS, Petrucci RJ, Baessler C: The effect of psychological intervention on patients' long-term adjustment to the ICD: a prospective study. Pacing Clin Electrophysiol 23:450–456, 2000
[PubMed]
 
Kraaij V, de Wilde EJ: Negative life events and depressive symptoms in the elderly: a life span perspective. Aging Ment Health 5:84–91, 2001
[PubMed]
 
Kraaij V, Arensman E, Spinhoven P: Negative life events and depression in elderly persons: a meta-analysis. J Gerontol B Psychol Sci Soc Sci 57:P87–P94, 2002
 
Krishnan KR, Goli V, Ellinwood EH, et al: Leukoencephalopathy in patients diagnosed as major depressive. Biol Psychiatry 23:519–522, 1988 [Erratum in: Biol Psychiatry 25(6):822, 1989]
 
Krishnan KR, McDonald WM, Escalona PR, et al: Magnetic resonance imaging of the caudate nuclei in depression: preliminary observations. Arch Gen Psychiatry 49:553–557, 1992
[PubMed]
 
Krishnan KR, McDonald WM, Doraiswamy PM, et al: Neuroanatomical substrates of depression in the elderly. Eur Arch Psychiatry Clin Neurosci 243:41–46, 1993
[PubMed]
 
Krishnan KR, Hays JC, Blazer DG: MRI-defined vascular depression. Am J Psychiatry 154:497–501, 1997
[PubMed]
 
Krishnan KR, Doraiswamy PM, Clary CM: Clinical and treatment response characteristics of late-life depression associated with vascular disease: a pooled analysis of two multicenter trials with sertraline. Prog Neuropsychopharmacol Biol Psychiatry 25:347–361, 2001
[PubMed]
 
Krishnan KR, Taylor WD, McQuoid DR, et al: Clinical characteristics of magnetic resonance imaging–defined subcortical ischemic depression. Biol Psychiatry 55:390–397, 2004
[PubMed]
 
Kumar A, Mintz J, Bilker W, et al: Autonomous neurobiological pathways to late-life depressive disorders: clinical and pathophysiological implications. Neuropsychopharmacology 26:229–236, 2002
[PubMed]
 
Lenze EJ, Munin MC, Skidmore ER, et al: Onset of depression in elderly persons after hip fracture: implications for prevention and early intervention of late-life depression. J Am Geriatr Soc 55:81–86, 2007
[PubMed]
 
Li YS, Meyer JS, Thornby J: Longitudinal follow-up of depressive symptoms among normal versus cognitively impaired elderly. Int J Geriatr Psychiatry 16:718–727, 2001
[PubMed]
 
Liverman C, Blazer D (eds): Testosterone and Aging: Clinical Research Directions. Washington, DC, National Academies Press, 2004
 
Livingston G, Manela M, Katona C: Depression and other psychiatric morbidity in carers of elderly people living at home. BMJ 312:153–156, 1996
[PubMed]
 
Luisi S, Tonetti A, Bernardi F, et al: Effect of acute corticotropin releasing factor on pituitary-adrenocortical responsiveness in elderly women and men. J Endocrinol Invest 21:449–453, 1998
[PubMed]
 
Lustman PJ, Griffith LS, Freedland KE, et al: Cognitive behavior therapy for depression in type 2 diabetes mellitus: a randomized, controlled study. Ann Intern Med 129:613–621, 1998
[PubMed]
 
Lyketsos CG, Sheppard JM, Steele CD, et al: Randomized, placebo-controlled, double-blind, clinical trial of sertraline in the treatment of depression complicating Alzheimer's disease: initial results from the Depression in Alzheimer's Disease Study. Am J Psychiatry 157:1686–1689, 2000
[PubMed]
 
Lyles KW: Osteoporosis and depression: shedding more light upon a complex relationship. J Am Geriatr Soc 49:827–828, 2001
[PubMed]
 
Lyness JM, Caine ED, King DA, et al: Depressive disorders and symptoms in older primary care patients. Am J Geriatr Psychiatry 10:275–282, 2002
[PubMed]
 
Magaziner J, Simonsick EM, Kashner TM, et al: Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 45:M101–M107, 1990
 
Manly DT, Oakley SP Jr, Bloch RM: Electroconvulsive therapy in old-old patients. Am J Geriatr Psychiatry 8:232–236, 2000
[PubMed]
 
Massey EW, Bullock R: Peroneal palsy in depression. J Clin Psychiatry 39:287, 291–292, 1978
 
Meyers BS, Kalayam B, Mei-Tal V: Late-onset delusional depression: a distinct clinical entity? J Clin Psychiatry 45:347–349, 1984
[PubMed]
 
Mischoulon D, Burger JK, Spillmann MK, et al: Anemia and macrocytosis in the prediction of serum folate and vitamin B12 status, and treatment outcome in major depression. J Psychosom Res 49:183–187, 2000
[PubMed]
 
Mojtabai R, Olfson M: Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. Psychol Med 34:623–634, 2004
[PubMed]
 
Morley J, Kraenzle D: Causes of weight loss in a community nursing home. J Am Geriatr Soc 42:583–585, 1994
[PubMed]
 
Morse JQ, Lynch TR: A preliminary investigation of self-reported personality disorders in late life: prevalence, predictors of depressive severity, and clinical correlates. Aging Ment Health 8:307–315, 2004
[PubMed]
 
Murphy E: Social origins of depression in old age. Br J Psychiatry 141:135–142, 1982
[PubMed]
 
Murphy E: The prognosis of depression in old age. Br J Psychiatry 142:111–119, 1983
[PubMed]
 
Murphy E, Smith R, Lindesay J, et al: Increased mortality rates in late-life depression. Br J Psychiatry 152:347–353, 1988
[PubMed]
 
Musselman DL, Evans DL, Nemeroff CB: The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry 55:580–592, 1998
[PubMed]
 
Nyth AL, Gottfries CG: The clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders: a Nordic multicentre study. Br J Psychiatry 157:894–901, 1990
[PubMed]
 
O'Conner M, Knapp R, Husain M, et al: The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. Report. Am J Geriatr Psychiatry 9:382–390, 2001
 
Olin J, Schneider L, Katz I, et al: Provisional diagnostic criteria for depression of Alzheimer disease. Am J Geriatr Psychiatry 10:125–128, 2002
[PubMed]
 
Parker G, Roy K, Hadzi-Pavlovic D, et al: The differential impact of age on the phenomenology of melancholia. Psychol Med 31:1231–1236, 2001
[PubMed]
 
Parmelee PA, Katz IR, Lawton MP: Depression among institutionalized aged: assessment and prevalence estimation. J Gerontol 44:M22–M29, 1989
 
Penninx BW, Geerlings SW, Deeg DJ, et al: Minor and major depression and the risk of death in older persons. Arch Gen Psychiatry 56:889–895, 1999a
 
Penninx BW, Leveille S, Ferrucci L, et al: Exploring the effect of depression on physical disability: longitudinal evidence from the Established Populations for Epidemiologic Studies of the Elderly. Am J Public Health 89:1346–1352, 1999b
 
Pollock BG: Geriatric psychiatry: psychopharmacology: general principles, in Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Edited by Sadock BJ, Sadock VA. Baltimore, MD, Williams and Wilkins, 2000, pp 3086–3090
 
Post F: The Significance of Affective Symptoms at Old Age. London, Oxford University Press, 1962
 
Post F: The management and nature of depressive illnesses in late life: a follow-through study. Br J Psychiatry 121:393–404, 1972
[PubMed]
 
Post F: The functional psychoses, in Geriatric Psychiatry. Edited by Isaacs A, Post F. New York, Wiley, 1978, pp 77–98
 
Pressman P, Lyons JS, Larson DB, et al: Religious belief, depression, and ambulation status in elderly women with broken hips. Am J Psychiatry 147:758–760, 1990
[PubMed]
 
Price TR, McAllister TW: Safety and efficacy of ECT in depressed patients with dementia: a review of clinical experience. Convuls Ther 5:61–74, 1989
[PubMed]
 
Prigerson H, Reynolds CF 3rd, Frank E, et al: Stressful life events, social rhythms, and depressive symptoms among the elderly: an examination of hypothesized causal linkages. Psychiatry Res 51:33–49, 1994
[PubMed]
 
Prince MJ, Harwood RH, Thomas A, et al: A prospective population-based study of the effects of disablement and social milieu on the onset and maintenance of late-life depression: the Gospel Oak Project VII. Psychol Med 28:337–350, 1998
[PubMed]
 
Rabkin JG, Charles E, Kass F: Hypertension and DSM-III depression in psychiatric outpatients. Am J Psychiatry 140:1072–1074, 1983
[PubMed]
 
Radloff LS: The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1:385–401, 1977
 
Rapaport MJ, Mamdani M, Herrman N: Electroconvulsive therapy in older adults: 13-year trends. Can J Psychiatry 51:616–619, 2006
 
Raskin J, Xu JY, Kajdasz DK: Time to response for duloxetine 60 mg once daily versus placebo in elderly patients with major depressive disorder. Int Psychogeriatr 20:309–327, 2008
[PubMed]
 
Reynolds CF 3rd, Frank E, Perel JM, et al: Combined pharmacotherapy and psychotherapy in the acute and continuation treatment of elderly patients with recurrent major depression: a preliminary report. Am J Psychiatry 149:1687–1692, 1992
[PubMed]
 
Reynolds CF 3rd, Frank E, Perel JM, et al: Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. JAMA 281:39–45, 1999
[PubMed]
 
Reynolds CF 3rd, Dew MA, Pollock BG, et al: Maintenance treatment of major depression in old age. N Engl J Med 354:1130–1138, 2006
[PubMed]
 
Roberts RE, Kaplan GA, Shema SJ, et al: Does growing old increase the risk for depression? Am J Psychiatry 154:1384–1390, 1997
[PubMed]
 
Robinson RG, Price TR: Post-stroke depressive disorders: a follow-up study of 103 patients. Stroke 13:635–641, 1982
[PubMed]
 
Rosenbach ML, Hermann RC, Dorwart RA: Use of electroconvulsive therapy in the Medicare population between 1987 and 1992. Psychiatr Serv 48:1537–1542, 1997
[PubMed]
 
Rovner BW, German PS, Brant LJ, et al: Depression and mortality in nursing homes. JAMA 265:993–996, 1991 [Erratum in: JAMA 265(20):2672, 1991]
 
Sapolsky RM: Why stress is bad for your brain. Science 273:749–750, 1996
[PubMed]
 
Sapolsky RM: Depression, antidepressants, and the shrinking hippocampus. Proc Natl Acad Sci U S A 98:12320–12322, 2001
[PubMed]
 
Schleifer SJ, Macari-Hinson MM, Coyle DA, et al: The nature and course of depression following myocardial infarction. Arch Intern Med 149:1785–1789, 1989
[PubMed]
 
Schulz R, Drayer RA, Rollman BL: Depression as a risk factor for non-suicide mortality in the elderly. Biol Psychiatry 52:205–225, 2002
[PubMed]
 
Scott J, Teasdale JD, Paykel ES, et al: Effects of cognitive therapy on psychological symptoms and social functioning in residual depression. Br J Psychiatry 177:440–446, 2000
[PubMed]
 
Seidman SN, Araujo AB, Roose SP, et al: Low testosterone levels in elderly men with dysthymic disorder. Am J Psychiatry 159:456–459, 2002
[PubMed]
 
Sheline YI: Neuroimaging studies of mood disorder effects on the brain. Biol Psychiatry 54:338–352, 2003
[PubMed]
 
Sheline YI, Wang PW, Gado MH, et al: Hippocampal atrophy in recurrent major depression. Proc Natl Acad Sci U S A 93:3908–3913, 1996
[PubMed]
 
Sheline YI, Mintun MS, Moerlein SM, et al: Greater loss of 5-HT(2A) receptors in midlife than in late life. Am J Psychiatry 159:430–435, 2002
[PubMed]
 
Sherwin B, Gelfand M: Sex steroids and affect in the surgical menopause: a double-blind, cross-over study. Psychoneuroendocrinology 10:325–335, 1985
[PubMed]
 
Shulman KI: Mania in old age, in Affective Disorders in the Elderly. Edited by Murphy E. Edinburgh, Scotland, Churchill Livingstone, 1986, pp 203–216
 
Shulman KI: The influence of age and aging on manic disorder. Int J Geriatr Psychiatry 4:63–65, 1989
 
Shulman K, Post F: Bipolar affective disorder in old age. Br J Psychiatry 136:26–32, 1980
[PubMed]
 
Smith GS, Gunning-Dixon FM, Lotrich FE, et al: Translational research in late-life mood disorders: implications for future intervention and prevention research. Neuropsychopharmacology 32:1857–1875, 2007
[PubMed]
 
Spar JE, Ford CV, Liston EH: Bipolar affective disorder in aged patients. J Clin Psychiatry 40:504–507, 1979
[PubMed]
 
Spiegel D: Cancer and depression. Br J Psychiatry 169(suppl):109–116, 1996
 
Staab JP, Evans DL: Efficacy of venlafaxine in geriatric depression. Depress Anxiety 12 (suppl 1):63–68, 2000
 
Steffens DC, Payne ME, Greenberg DL, et al: Hippocampal volume and incident dementia in geriatric depression. Am J Geriatr Psychiatry 10:62–71, 2002
[PubMed]
 
Steuer JL, Mintz J, Hammen CL, et al: Cognitive-behavioral and psychodynamic group psychotherapy in treatment of geriatric depression. J Consult Clin Psychol 52:180–189, 1984
[PubMed]
 
Stoudemire A, Hill CD, Morris R, et al: Long-term outcome of treatment-resistant depression in older adults. Am J Psychiatry 150:1539–1540, 1993
[PubMed]
 
Stoudemire A, Hill CD, Morris R, et al: Improvement in depression-related cognitive dysfunction following ECT. J Neuropsychiatry Clin Neurosci 7:31–34, 1995
[PubMed]
 
Stoudemire A, Hill CD, Marquardt M, et al: Recovery and relapse in geriatric depression after treatment with antidepressants and ECT in a medical-psychiatric population. Gen Hosp Psychiatry 20:170–174, 1998
[PubMed]
 
Sullivan MD, LaCroix AZ, Baum C, et al: Functional status in coronary artery disease: a one year prospective study of the role of anxiety and depression. Am J Med 103:348–356, 1997
[PubMed]
 
Takeshita J, Masaki K, Ahmed I, et al: Are depressive symptoms a risk factor for mortality in elderly Japanese American men? The Honolulu Asia Aging Study. Am J Psychiatry 159:1127–1132, 2002
[PubMed]
 
Taylor WS, Steffens DC, MacFall JR, et al: White matter hyperintensity progression and late-life depression outcomes. Arch Gen Psychiatry 60:1090–1096, 2003
[PubMed]
 
Tew JD Jr, Mulsant BH, Haskett RF, et al: Acute efficacy of ECT in the treatment of major depression in the old-old. Am J Psychiatry 156:1865–1870, 1999
[PubMed]
 
Thakur M, Hays J, Ranga K [sic], Krishnan KRR: Clinical, demographic, and social characteristics of psychotic depression. Psychiatry Res 86:99–106, 1999
[PubMed]
 
Thomas C, Kelman HR, Kennedy GJ, et al: Depressive symptoms and mortality in elderly persons. J Gerontol 47:S80–S87, 1992
 
Thompson LW, Gallagher D, Breckenridge JS: Comparative effectiveness of psychotherapies for depressed elders. J Consult Clin Psychol 55:385–390, 1987
[PubMed]
 
Turner R, Turner J: Social integration and support, in Handbook of Sociology of Mental Health. Edited by Aneshensel C, Phelan J. New York, Kluwer Academic, 1999, pp 301–319
 
Waite A, Bebbington P, Skelton-Robinson M, et al: Social factors and depression in carers of people with dementia. Int J Geriatr Psychiatry 19:582–587, 2004
[PubMed]
 
Weihs KL, Settle EC Jr, Batey SR, et al: Buproprion sustained release versus paroxetine for the treatment of depression in the elderly. J Clin Psychiatry 61:196–202, 2000
[PubMed]
 
Weissman MM, Prusoff BA, Klerman GL: Personality and the prediction of long-term outcome in depression. Am J Psychiatry 135:797–800, 1978
[PubMed]
 
Weissman MM, Bruce ML, Leaf PJ, et al: Affective disorders, in Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. Edited by Robins LN, Regier DA. New York, Free Press, 1991, pp 53–80
 
Wesner RB, Winokur G: The influence of age on the natural history of unipolar depression when treated with electroconvulsive therapy. Eur Arch Psychiatry Neurol Sci 238:149–154, 1989
[PubMed]
 
Whooley MA, Browner WS: Association between depressive symptoms and mortality in older women: study of Osteoporotic Fractures Research Group. Arch Intern Med 158:2129–2135, 1998
[PubMed]
 
Whyte EM, Pollock BG, Wagner WR, et al: Influence of serotonin-transporter-linked region polymorphism on platelet activation in geriatric depression. Am J Psychiatry 158:2074–2076, 2001
[PubMed]
 
Williams SA, Kasl SV, Heiat A, et al: Depression and risk of heart failure among the elderly: a prospective community-based study. Psychosom Med 64:6–12, 2002
[PubMed]
 
Winokur G: The Iowa 5000: heterogeneity and course of manic-depressive illness (bipolar). Compr Psychiatry 16:125–131, 1975
[PubMed]
 
Wylie ME, Mulsant BH, Pollock BG, et al: Age of onset in geriatric bipolar disorder: effects on clinical presentation and treatment outcomes in an inpatient sample. Am J Geriatr Psychiatry 7:77–83, 1999
[PubMed]
 
Yassa R, Nair V, Nastase C, et al: Prevalence of bipolar disorder in a psychogeriatric population. J Affect Disord 14:197–201, 1988
[PubMed]
 
Yesavage JA, Brink TL, Rose TL, et al: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49, 1983
 
Young RC, Falk JR: Age, manic psychopathology, and treatment response. Int J Geriatr Psychiatry 4:73–78, 1989
 
Young RC, Klerman GL: Mania in late life: focus on age at onset. Am J Psychiatry 149:867–876, 1992
[PubMed]
 
Zesiewicz TA, Gold M, Chari G, et al: Current issues in depression in Parkinson's disease. Am J Geriatr Psychiatry 7:110–118, 1999
[PubMed]
 
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Sample questions:
1.
You diagnose major depression in a physically healthy 76-year-old woman and recommend to her antidepressant medication. She responds by saying, "What's the use? I've heard that antidepressants are not very effective in older people." You state that if seniors are treated with an adequate dose of an antidepressant for a sufficient period of time (at least 6–9 months) they may expect a recovery rate of approximately
2.
Factors associated with improved outcome in late-life depression include which of the following?
3.
Certain psychological factors may contribute to the onset of late-life depressive symptoms. All of the following factors have been reported by investigators to increase the likelihood or frequency of late-life depressive symptoms except
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