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Depression in the Older Adult

      Depression is the prototype of mood disorders in the older adult and can be defined as a painful emotional experience characterized by loss of interest or pleasure in life sufficient to affect function [
      • Koenig H.G.
      • Blazer D.G.
      Depression, anxiety, and other mood disorders.
      ]. Depression, however, is not a single clinical entity. The depressive disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) [
      • American Psychological Association
      Diagnostic and statistical manual of mental disorders.
      ] (Appendix 5b of this issue) are distinguished from one another based on a host of symptoms and signs. Conventional wisdom suggests that these disorders are common among older patients encountered in the primary care setting and that they are responsive to treatment. Challenging this conventional wisdom is a study conducted in the Netherlands that focuses on the natural history of late-life major depression, subthreshold depression, and dysthymic disorder. The study's findings suggest that DSM affective disorders are relatively rare in older adults and that outcomes are poor [
      • Beekman A.T.
      • Geerlings S.W.
      • Deeg D.J.
      • et al.
      The natural history of late-life depression: a 6-year prospective study in the community.
      ]. In contrast to major depression, clinically significant depressive symptoms that affect function and quality of life are frequent, leading some experts to question the usefulness of DSM criteria when assessing older adults [
      • Hybels C.F.
      • Blazer D.G.
      Epidemiology of late-life mental disorders.
      ].
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