Editorials

Treating depression in later life

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7459.181 (Published 22 July 2004) Cite this as: BMJ 2004;329:181
  1. Carolyn Chew-Graham, senior lecturer in primary care,
  2. Robert Baldwin, consultant psychiatrist,
  3. Alistair Burns (A_Burns@fs1.with.man.ac.uk), professor of old age psychiatry
  1. Rusholme Academic Unit, Rusholme Health Centre, Manchester M14 5NP
  2. Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester M13 9WL
  3. Education and Research Centre, Wythenshawe Hospital, Manchester M23 9PL

    We need to implement the evidence that exists

    The three major mental health problems affecting older people are dementia, delirium, and depression. Depressive disorders are the most common, affecting one in seven, a prevalence rate that is consistent across countries and cultures.1 Comparable rates for dementia and delirium are one in 17 and one in 25. Therapeutic optimism surrounds the management of dementia and delirium, but the development of new management approaches in late life depression has been neglected, perhaps because of stigma. Twenty years ago, a rule of three was proposed in this journal: a third of older depressed people get better, a third remain the same, and a third get worse.2 This rule is still applicable today despite the availability and efficacy of treatments that could substantially improve these ratios. Depression late in life is associated with serious morbidity and mortality, including suicide.3 The national service framework for older people targets stroke, falls, dementia, and depression, but only the first three seem to attract …

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