Despite its prevalence and seriousness,
depressionin late
life remains underappreciated as a sourceof
disability and suffering for older people andtheir
families. Despite a solid and substantial bodyof
research, recognition of depression remainsproblematic
and is often attributed to normaldevelopmental changes in aging. Treatment
effi-cacy data
notwithstanding, the adequacy andappropriateness of treatment is highly
variable.This
paper contains a broad overview of newresearch developments in depression
in late lifeand
the disabilities associated with it. Serving asan
introduction to the specific papers that followin
this issue of Dialogues in Clinical Neuroscience,this article scans the knowledge base
in basic, clin-ical,
and health services research, identifying thehighlights
of current work in the area and propos-ing
areas of needed expansion of research efforts. hree
factors combine to make depression inlate
life a primary concern in worldwide public health.First, the
global population is growing older, gainingnearly
30 years of life expectancy in this century.1 Sec-ond, our appreciation of the disabling
consequences ofdepression
has been underscored by the landmarkreport of the World Health Organization
on the “globalburden
of disease.”2 Third, the tools
of contemporaryneuroscience
have significantly enhanced our under-standing
of the pathophysiologic and etiologic mecha-nisms
of depression.3-7Depression
in older people is a significant public healthproblem.8 It
is the cause of unnecessary suffering forthose
whose illness is unrecognized or inadequatelytreated, and
it burdens families and institutions provid-ing
care for the elderly. Because of the stereotypic notionthat older people are necessarily beset
by many physicalillnesses
and social and economic problems, clinicians,family
members, and older people themselves often con-clude
that depression is a normal condition of late life.Clinically, the
symptom of depressed mood may be lesscommonly
reported than a variety of somatic complaints,sleep
and appetite change, and general loss of interest.9These factors combine to make diagnosis
and treatmentof
depression highly variable and problematic.10 This paper, and the other papers
in this issue, will demon-strate
that depression in older people is widespread andserious, and
that the comorbidity of depression withother
illnesses is particularly significant. Moreover, wewill show that depression can be diagnosed
in the olderpatient
and that it can be differentiated from normalaging. Importantly, a
variety of treatments have beendemonstrated
to be safe and efficacious in the elderly,and
long-term treatment might be indicated.Onset
and course of depressionDepression
in late life is a very heterogeneous condi-tion. Onset
may be early in life with the course recurrentfrom
a first episode earlier in adulthood, or the onset ofthe first episode may be late in life. In
general, comparedS t a t e
o f t h e a r tDepression
in late lifeBarry
D. Lebowitz, PhDTAddress
for correspondence: Dr Barry D. Lebowitz, Adult and Geriatric
Treatment and Preventive Interventions Research
Branch, National Institute of Mental Health, 6001 Executive
Blvd, rm 7160 MSC
9635, Bethesda,
MD 20892-9635, USA.
(e-mail: blebowit@mail.nih.gov) Author
affiliations: Adult and Geriatric Treatment and Preventive Interventions
Research Branch, National Institute of Mental Health, Bethesda, Md, USA Keywords:
epidemiology; pathophysiology; natural history; disability;
pharmacology; psychotheapy; convulsive therapy; health services; suicide5 7
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