Evidence-based pharmacologic interventions for geriatric depression.

Geriatric depression is a growing public health problem [1,2]. The estimated prevalence of geriatric major depression in the general population is 1% to 2% [3,4]. Depressive symptoms not meeting the criteria for major depression occur in approximately 15% of older adults [5]. The prevalence of major depression in community-dwelling older adults is 1% to 3%, but the prevalence is at least 10% to 12% in primary care and hospital inpatient settings [6]. Despite the common prevalence of depression in older adults, late-life depression is often under-recognized and under-treated, particularly in nonpsychiatric settings [4]. Major depression is a leading cause of disability in adults [7]. In elderly patients, both depression and medical illness have an additive effect on disability and lead to an increase in mortality and nursing home placement [8,9]. Depression severity is a predictor of variance in instrumental activities of daily living [10]. The mechanisms linking depression and disability are still unclear, but it appears that the depressed state itself can be disabling, and depression increases the disability caused by chronic medical conditions [11]. Bruce and colleagues [12] have described a mutually reinforcing, downward-spiraling relationship between depression and disability. In contrast, treatment that results in a reduction in the severity of depression leads,