Depression in the elderly.

Depression in the elderly is difficult to classify and may be more of a symptom than a disease entity. The core problem with the elderly is inability to handle multiple losses. Feelings of helplessness and reduced self-esteem are significant. The resultant depression often appears mild but the risk of suicide cannot be ignored. The family physician is the key person in the diagnosis of depression. The close relationship between physical factors and depression may make differentiation difficult. Treatment involves a sympathetic but firm approach, particularly when dealing with the hypochondriacal patient. Regression in the elderly is a serious problem that requires staff teamwork. Reactivation techniques which combat feelings of helplessness and hopelessness are of particular importance. When the patient no longer responds well to appropriate drugs, electroconvulsive treatment may be of value. Family and marital therapy should not be overlooked. The nihilist has no place in geriatric medicine.