Treatment-Resistant Depression in the Elderly: Diagnostic and Treatment Approaches

Abstract

Depression is a common illness in the geriatric primary care population. Risk factors including serious medical illness and functional disability, as well as neurodegeneration and cardiovascular risk factors, can make treatment particularly difficult in late-life depression. There is a paucity of well-validated evidence to guide the geriatric clinician’s diagnosis and management of treatment-resistant late-life depression (TRLLD). In this article, I provide clinical recommendations for the evaluation and diagnosis of late-life depression appropriate for the geriatric primary care provider. With an accurate diagnosis, the geriatric physician can better construct a treatment plan. I will review evidence-based treatment approaches for TRLLD including antidepressant medications, augmentation strategies, psychotherapy options, and neuromodulation techniques.