Intended for healthcare professionals

Clinical Review

Depression in older adults

BMJ 2011; 343 doi: (Published 28 September 2011) Cite this as: BMJ 2011;343:d5219
  1. Joanne Rodda, clinical training fellow in old age psychiatry,
  2. Zuzana Walker, reader in old age psychiatry,
  3. Janet Carter, senior lecturer in old age psychiatry
  1. 1Department of Mental Health Sciences, University College London, London W1W 7EJ, UK
  1. Correspondence to: J Carter j.carter{at}
  • Accepted 28 July 2011

Summary points

  • Depression in older adults is associated with an increased risk of death and disability

  • Cognitive and functional impairment and anxiety are more common in older than in younger adults with depression

  • Older adults with depression are at increased risk of suicide and are more likely than younger adults to complete suicide

  • Depression is associated with cognitive impairment and an increased risk of dementia

  • A selective serotonin reuptake inhibitor should be the first line pharmacological treatment for depression for most older adults, including those with chronic physical illness

  • Psychological and drug treatment is as effective in older as in younger adults

  • Subthreshold depressive symptoms that substantially affect older patients’ lives are common and management with psychosocial and drug strategies may be effective and prevent further deterioration

Depression is a major contributor to healthcare costs and is projected to be the leading cause of disease burden in middle and higher income countries by the year 2030.w1 Depression in later life, traditionally defined as age older than 65, is associated with disability, increased mortality, and poorer outcomes from physical illness. Most clinicians will encounter older patients with depression in their day to day practice, but although treatment is as effective for older patients as for younger adults, the condition is often under-recognised and under-treated. According to WHO data, proportionately more people aged over 65 commit suicide than any other age group, and most have major depression. Older people who attempt suicide are more likely to die than younger people, while in those who survive, prognosis is worse for older adults.1

With a progressively ageing population worldwide, identification and treatment of depression in older adults becomes increasingly important, especially as older patients may have different presentations and needs than younger ones. We consider recent systematic reviews, meta-analyses, and randomised controlled trials to …

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