Depression is one of the most common, disabling, and costly conditions encountered in older primary care patients. Using the case of a 69-year-old woman who struggled with prolonged depression and comorbid medical illnesses, this article summarizes effective strategies for detection and treatment of late-life depression. Clinicians should screen older patients for depression using a standard rating scale, initiate effective treatment such as antidepressant medications or evidence-based psychotherapies, and carefully follow for improvement of depression symptoms. Patients who are not improving should be considered for psychiatric consultation and additional treatments such as electroconvulsive therapy (ECT). Several changes in treatment are often needed before patients achieve remission, and maintenance treatment and relapse prevention planning can reduce the risk of relapse. Evidence-based collaborative programs, in which primary care providers work closely with special mental health providers, following a measurement-based treatment-to-target approach have been shown to be significantly more effective than usual primary care.
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