Peer Reviewed
Feature Article Dementia

Severe depression in old age

John Snowdon
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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