i1913-701X-145-3-128.pdf

128 C P J / R P C  ?  M AY / J U N E  2 0 1 2  ?  VO L  1 4 5 ,  N O  3 Introduction Geriatric(orlate-life)depressionreferstodepres- sive syndromes that develop in people aged 65 yearsorolder.1Depressivesyndromescommonly affectolderpeoplewithchronicdisease,cognitive impairmentorotherformsofdisability.2-5Depres- sionpromotesdisabilityinthispopulationandis associatedwithnegativeoutcomesofchronicdis- ease,suchasincreasedhealthcareutilizationand mortality.2Geriatricdepressionisoftenundetected orundertreatedinprimarycaresettingsforvari- ousreasons,includingthe(incorrect)beliefthat depressionisanormalpartofaging.Ithasbeen predictedbytheWorldHealthOrganizationthat by2020depressionwillbesecondonlytoheart disease as a cause of disability and premature death in developed countries.6 The purpose of thisreviewistodiscussselectedissuesingeriatric depression,withafocusonpharmacotherapeutic considerations. Diagnosis DepressionisusuallydiagnosedusingtheAmeri- canPsychiatricAssociation’sDiagnostic and Statis- tical Manual of Mental Disorders,FourthEdition, Text Revision (DSM-IV-TR) criteria formajor depressivedisorder.1Specifically,5ofthefollowing symptomsmustbepresent:diminishedinterest, lossofpleasureinalloralmostallactivities,weight lossorgain(5%ofbodyweight),insomniaor hypersomnia,psychomotoragitationorretarda- tion, fatigue, feelings ofworthlessness or inap- propriateguilt,reducedabilitytoconcentrateor recurrentthoughtsofdeathorsuicide.Thediag- nosisofdepressionrequiresthateitherdepressed moodoranhedoniabepresent,thatthesyndrome last at least2weeks, that it lead todistressand functionalimpairmentandthatitnotbeadirect effectofsubstanceabuse,amedicalconditionor bereavement.While the DSM-IV-TR does not specifydifferentsy