Altersdepression erkennen und behandeln

Late-life depression often lacks sadness

Diagnostic criteria are not age-specific. In late life, depression can present without overt depressed mood, with anhedonia and reduced drive predominating. Severity classification counts symptoms rather than their intensity and therefore has limited clinical usefulness.

Suicide risk concentrates in older men

In population-based data, late-life depression and recurrence are relatively uncommon outside highly selected settings. However, suicide rates are highest in older, especially very old, men, making this group particularly relevant for clinical attention.

Treatment follows severity and stepwise escalation

Mild-to-moderate depression allows psychotherapy and/or antidepressants; severe depression requires both. SSRIs are first-line; duloxetine is a second-step option. In treatment resistance, augmentation—particularly with aripiprazole, then lithium—shows benefit. Antidepressants also prevent relapse effectively.

In the seminar “Altersdepression erkennen und behandeln,” Dr. med. Florian Riese from the geriatric psychiatry service of the PUK Zürich discusses the diagnosis and treatment of late-life depression; the continuing education event is organized by Klinik Barmelweid. He emphasizes that no age-specific diagnostic criteria exist, so assessment relies on ICD-10 criteria, while clinically relevant late-life depression may present without overt depressed mood and instead with anhedonia, reduced drive, and nonspecific “flatness.” Based on epidemiological data cited in the lecture, he states that depression in older adults is relatively uncommon in non-selected community populations, recurrence is also not especially frequent, and the commonly assumed increase with age or clear female predominance is not consistently confirmed outside highly selected clinical settings. At the same time, he underlines the clinical importance of the disorder because of substantial suffering and the elevated suicide risk in older men, particularly in the very old. For treatment, he presents guideline-based stratification by severity: psychotherapy and/or antidepressants for mild to moderate depression, combined psychotherapeutic and pharmacological treatment for severe depression, and psychosocial interventions across all severity levels. In pharmacotherapy, he describes SSRIs—especially citalopram, escitalopram, and sertraline—as first-line agents in older adults, notes duloxetine as a possible second-step SNRI, and reviews strategies for treatment resistance including augmentation with aripiprazole or lithium, switching to nortriptyline, and in refractory cases ketamine, rTMS, or ECT. He also points out that antidepressant effects can begin within days rather than only after two weeks, that continuation therapy is particularly important for relapse prevention, and that discontinuation syndromes after antidepressant withdrawal are clinically relevant and require gradual tapering.