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Am Fam Physician. 1998;57(8):2013

Staff members of the National Institute of Mental Health and other experts that participated in the National Institutes of Health Consensus Development Conference on Diagnosis and Treatment of Depression in Late Life in 1991 recently convened to reexamine the conclusions of the 1991 conference and update information in the light of new scientific developments. The participants reviewed the original consensus statement and identified areas for updating. The update was published in the October 8, 1997, issue of JAMA.

The initial 1991 panel concluded that depressive illness is widespread in the elderly population, that depression in late life is a serious public health concern and that comorbidity of depression with other illnesses is a significant problem in older persons. It was also concluded that depression in late life can be differentiated from the changes associated with normal aging and that it is a treatable condition in this age group. The panel that provided the update of the statement believes that the findings of the initial consensus statement still hold true and that depression in older persons remains a significant public health problem, but there has been significant progress in the understanding of the nature, clinical course and treatment of late-life depression.

Highlights of the new findings reported in the update include the following:

  • An association between late-onset depression and brain abnormalities and vascular disease has been noted. Late-life depression with cognitive impairment that reversed by antidepressant treatment may be a predictor of irreversible dementia.

  • Depression coexisting with physical illness increases levels of functional disability.

  • Clinically significant depression is a spectrum disorder rather than a categorical disease entity. Subsyndromal depression has a variety of names (e.g., subsyndromal symptomatic depression, subclinical depression, mild depression, subdysthymic depression).

  • Hormones may play an important role in depression.

  • New antidepressant treatments, including the selective serotonin reuptake inhibitors and standardized psychotherapies, have been effective.

  • Long-term treatment is needed in late-life depression

  • A clear relationship between depression and suicide has been established, especially in the elderly.

The update states that depression should be viewed as sentinel event that increases the risk for declines in health status and functional ability. The goals of treatment are improve symptoms, prevent relapse and recurrence, and improve the quality of life. Early recognition, diagnosis and initiation of treatment of depression in older persons by primary care physicians present opportunities for improvements in the quality of life and functional capacity, and the prevention of premature deaths. The panel believes that future research needs to focus on all aspects of depression in late life.

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