1 The epidemiology of depressive disorders in late life by Dan G. Blazer 3
2 The social and financial burden of late-life depression to society and individuals by Barry D. Lebowitz and Jason T. Olin 12
3 Unipolar depression by George S. Alexopoulos and William Apfeldorf 21
4 Bipolar disorders by Robert C. Young 34
5 Dysthymic disorder in the elderly by D. P. Devanand 49
6 Nonmajor clinically significant depression in the elderly by Anand Kumar and Helen Lavretsky and Virginia Elderkin-Thompson 64
7 Mixed cognitive and depressive syndromes by Helen Lavretsky and Gary W. Small 81
8 Suicide by Yeates Conwell 95
9 Bereavement and depression by Paula J. Clayton 107
10 Neuropsychological assessment of late-life depression by Wilfred G. Van Gorp and James C. Root and Harold A. Sackeim 117
11 Structural and functional brain imaging in late-life depression by Harold A. Sackeim 129
12 Late-life depression and the vascular hypothesis by K. Ranga and R. Krishnan 148
13 Hypothalamic-pituitary-adrenal axis activity in mood and cognition in the elderly : implications for symptoms and outcomes by Jennifer Keller and Theresa M. Buckley and Alan F. Schatzberg 157
14 The neuroendocrinology of aging by Stuart N. Seidman 167
15 Pharmacokinetics and pharmacodynamics in late life by Bruce G. Pollock 185
16 Antidepressant medication for the treatment of late-life depression by Steven P. Roose and Harold A. Sackeim 192
17 Antidepressant side effects by Carl Salzman 203
18 Mood stabilizers by Charles L. Bowden 211
19 Stimulants by J. Craig Nelson 222
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We live in an aging world. As a result, in years to come illnesses that are prevalent and cause significant morbidity and mortality in older people will consume an increasing share of health-care resources. One such illness is depression. This illness has a particularly devastating impact in the elderly because it is often undiagnosed or inadequately treated. Depression not only has a profound effect on the quality of life but it is also associated with an increased risk of mortality from suicide and vascular disease. In fact for every medical illness studied (e.g., heart disease, diabetes, cancer), individuals who are depressed have a worse prognosis. Research has illuminated the physiological and behavioral effects of depression that account for these poor outcomes. The deleterious relationship between depression and other illnesses has changed the concept of late-life depression from a "psychiatric disorder" that is diagnosed and treated by a psychiatrist to a common and serious disorder that is the responsibility of all physicians who care for patients over the age of 60 years.
This is the first volume devoted to the epidemiology, phenomenology, psychobiology, treatment, and consequences of late-life depression. Although much has been written about depressive disorders, the focus has been primarily on the illness as experienced in younger adults. The effects of aging on the brain, the physiological and behavioral consequences of recurrent depression, and the impact of other diseases common in the elderly make late-life depression a distinct entity. There is a compelling need for a separate research program, specialized treatments, and a book dedicated to this disorder. This volume will be invaluable to psychiatrists, gerontologists, clinical psychologists, social workers, students, trainees, and others who care for individuals over the age of 60 years.
