Psychotic vs. Nonpsychotic Depression in Older Patients

The authors analyzed data from 42 inpatients age 55 or older with major depression. Ten patients had psychotic depression, and 32 had nonpsychotic depression. There were no significant differences between the two groups in mean age at onset of depression, proportion of patients with previous episodes of depression, frequency of suicidal ideation, or number of family members with serious psychiatric illnesses. Patients with psychotic depression had greater severity of depression and more severe overall psychopathology at admission than the nonpsychotic group. Neuroleptics were used in a majority of the psychotic patients but in none of the nonpsychotic patients, whereas antidepressant use was similar. By the time of discharge, the two groups did not differ in severity of symptoms.

Depression IN THE ELDERLY

1. Depression in the elderly is a major health concern that can be life threatening if not recognized and treated. An untreated depression may result in needless suffering, institutionalization, and suicide. Lack of treatment may occur because the signs and symptoms of depression in the elderly are different from those in the young, and because depressive symptoms may be viewed by the older person, the family, and the physician as a normal part of aging. 2. Depression can occur secondarily to physical illness. Because physical illnesses occur frequently in the older population, the combination of physical illness and depression is common. 3. Through noninvasive procedures, such as positron emission tomography (PET), a greater understanding of depression will be achieved that will result in development of more specific and effective treatment. Accurate and early diagnosis and adequate treatment favor a good prognosis.