Depression in old age: a diagnostic and therapeutic challenge

In old age, depression mainly affects those with chronic medical illness, severe disability or mental decline. Depression in elderly worsens the outcomes of many medical illness and increases mortality. Age-related processes, including arteriosclerosis, inflammatory and degenerative diseases, may compromise the integrity of prefrontostriatal pathways and amygdala leading to increased vulnerability to depression. Environmental factors, such as impoverishment, isolation, relocation, caregiving and bereavement, contribute to further increase susceptibility to depression or triggering depression in already vulnerable elderly people. Suitable treatment of depression in elderly reduces the symptoms, prevents suicidal ideation, improves cognitive and functional status and helps patients to develop the skills needed to cope with their disability or psychosocial adversity. Prevention of depression in given pathological conditions may greatly improve the outcomes, mostly the recovery of function and quality of life, as well as the mortality risk. Therefore, it should be considered the opportunity of a depression prophylaxis, particularly in those circumstances in which the risk of depression is noteworthy increased, such as stroke, cancer, institutionalization, etc.