New Recommendations for Diagnosis and Treatment of Depression in Older Adults

​Major depression is common in older adults and can be treated with a variety of modalities. However, according to the authors of a literature review published in JAMA in May, it is often treated inadequately, "with a majority of patients receiving no treatment at all." Accordingly, the authors issued guidance on the management of depression in older adults—with particular attention to those who are frail and taking several medications for concurrent medical disorders. Because older adults are at risk for adverse events owing to multiple medical comorbidities and drug-drug interactions, the authors recommend that physicians use the Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria to ensure appropriate prescriptions, avoid undertreatment, and avoid failure to treat. While acknowledging the "limited evidence" developed by studying older individuals who have serious medical comorbidities, the authors found that major depression in older adults can be treated effectively with both antidepressants and electroconvulsive therapy.