Abstract:

Major depression, dysthymic disorders and subclinical depressions are common psychiatric problems after the age of 65. Bipolar depression in elderly, however, is either an aging previous patient or someone whose first attack has appeared on late life. The first step of treatment in the elderly depression is the investigation of the etiology for excluding any medical background. Treatment involves pharmacological agents such as antidepressants and mood stabilizer drugs, electroconvulsive therapy and various enforcement therapies. Response to drug therapy maybe more delayed than younger patients. Polypharmacy, and especially those drugs with anti-cholinergic properties should be avoided. The first line treatment of choice for geriatric depression should be serotonin-uptake-inhibitors (SSRI’s). Serotonin- noradrenaline re-uptake inhibitors (SNRI) may also be used. Mood stabilizers such as lithium, valproate, and carbamazepine should be utilized in much lower doses in older people, keeping in mind that they can easily be toxic. Insufficient double blind, randomized studies on the treatment of bipolar depression treatment in the elderly and the inadequacy of guidelines are the major downsides in this situation.

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