Feature Article

Severe depression in old age

John Snowdon

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Abstract

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.

Key Points

  • 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.

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