Management of treatment resistance in the depressed geriatric patient

The identification and treatment of depression in elderly patients often is problematic, particularly when a medical problem or physical dysfunction is an additional consideration. This article reviews the epidemiology of geriatric depression, addresses definitions of treatment resistance in this population, and discusses specific clinical problems that render adequate treatment difficult. The existing literature that addresses the utility of specific somatic therapies also is discussed. the article concludes with a discussion of the frail elderly, and recommendations for treatment planing are made.