Successful treatment of severe depression in old age depends on recognition of severe depression, identification of relevant causative factors and a combination of biological and psychosocial treatments. Treatment is often necessary on a prolonged basis to prevent recurrences.
- Severe depression in old age may be melancholia, psychotic depression, or loss-related or illness-associated.
- Psychosocial factors may precipitate or contribute to persistence of biological depressions.
- A combination of biological and psychosocial interventions will prove effective in most cases of severe depression.
- The essential first step in management of severe depression is to recognise it – which may be difficult if physical illness complaints dominate the presentation.
- Prolonged maintenance treatment will usually be necessary once severe depressions have been relieved.