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Diagnosis and management of late-life unipolar depression

Randall T Espinoza, MD, MPH
Jürgen Unützer, MD, MPH
Section Editors
Peter P Roy-Byrne, MD
Kenneth E Schmader, MD
Deputy Editor
David Solomon, MD


The term late-life depression includes both aging patients whose depressive disorder presented in earlier life, and patients whose disorder presents for the first time in later life. Depressive illness in the older population is a common and serious health concern that is associated with comorbidity, impaired functioning, excessive use of health care resources, and increased mortality (including suicide) [1].

Late-life depression remains underdiagnosed and inadequately treated [2-5]. In the United States, older men and older African Americans and Hispanics are at even greater risk of unrecognized depression [6-8]. The public health consequences of inadequately treated depression in late life will increase over time as the population continues to age.

Over 80 percent of mental health treatment for depressed older adults is delivered in the primary care setting. Depression often goes undiagnosed in primary care [9], and is often left untreated, even when diagnosed [10]. Recognition and management of late-life depression is an important responsibility for the primary care clinician. Either pharmacotherapy or psychotherapy can benefit patients [1].

This topic reviews the epidemiology, diagnosis, and treatment of late-life unipolar depression. The clinical features, assessment, diagnosis, and treatment of unipolar major depression in mixed age adults are discussed separately. (See "Unipolar depression in adults: Clinical features" and "Unipolar depression in adults: Assessment and diagnosis" and "Unipolar major depression in adults: Choosing initial treatment" and "Unipolar depression in adults: Treatment of resistant depression".)


Depression is not a normal consequence of aging [11,12]. Sadness and grief are normal responses to life events that occur with aging such as bereavement; adjustment to changes in social status with retirement and loss of income; transition from independent living to assisted or residential care; and loss of physical, social, or cognitive function from illness (see "Grief and bereavement in adults: Clinical features"). Despite these losses, healthy independent community-dwelling elderly in the United States have a lower prevalence rate of clinical depression than the general adult population (figure 1) [13].

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