Depression affects approximately 40% of patients with chronic obstructive pulmonary disease (COPD) and is largely untreated. This review draws on the author's studies and the available literature to examine the problem. Older people with COPD experience moderate levels of depression, but this goes largely unrecognized and untreated. The prevalence, severity and risk factors for depression in this population are discussed. Treatment, in the form of pulmonary rehabilitation and antidepressant drug therapy, are discussed, but in the absence of well-controlled trials, it is difficult to draw any firm conclusions about the benefits of these therapies. However, an appropriate home care package, with the support of respiratory nurses, is of some benefit to housebound patients with COPD because it helps to relieve depression and improve their quality of life, especially among those with a high level of depressive symptoms.