Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Aug 5;9(1):188.
doi: 10.1038/s41398-019-0514-6.

Mechanisms and treatment of late-life depression

George S Alexopoulos  1
Affiliations
Review

Mechanisms and treatment of late-life depression

George S Alexopoulos. Transl Psychiatry. .

Abstract

Depression predisposes to medical illnesses and advances biological aging indicated by shorter telomere length, accelerated brain aging and advanced epigenetic aging. Medical illnesses also increase the risk of late-life depression. The reciprocal relationships of depression with aging-related and disease-related processes have generated pathogenetic hypotheses and provided treatment targets. Targeting risk factors of vascular disease in mid-life is a logical approach in prevention of vascular depression. The depression-executive dysfunction and the vascular depression syndromes have clinical presentations and neuroimaging findings consistent with frontostriatal abnormalities. Dopamine D2/3 agonists are effective in depression of Parkinson's disease and their efficacy needs to be assessed in these two syndromes. Computerized cognitive remediation targeting functions of the cognitive control network may improve both executive functions and depressive symptoms of late-life major depression. Significant progress has been made in neurostimulation treatments in depressed younger adults. TMS targeting deep structures responsible for mood regulation is well tolerated by older adults and its efficacy in syndromes of late-life depression needs to be studied. Efficacious psychotherapies for late-life depression exist, but are underutilized in part because of their complexity. Streamlined, stepped psychotherapies targeting behaviors assumed to result from dysfunction of brain networks implicated in late-life depression can be easy to learn and have potential for dissemination. However, their effectiveness needs further investigation. Depression increases the risk of dementing disorders. Antidepressants are rather ineffective in treating depression of demented patients, but long-term use of antidepressants may reduce the risk of dementia. However, confirmation studies are needed.

PubMed Disclaimer

Conflict of interest statement

Dr. G.S.A. serves at the Speakers’ Bureaus of Allergan and Otsuka.

Figures

Fig. 1
Fig. 1
Reciprocal relationship of depression and medical health
Fig. 2
Fig. 2
Working model of late-life depression
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Han LKM, et al. Epigenetic aging in major depressive disorder. Am. J. Psychiatry. 2018;175:774–782. doi: 10.1176/appi.ajp.2018.17060595. - DOI - PMC - PubMed
    1. Penninx BW. Depression and cardiovascular disease: epidemiological evidence on their linking mechanisms. Neurosci. Biobehav. Rev. 2017;74(Pt B):277–286. doi: 10.1016/j.neubiorev.2016.07.003. - DOI - PubMed
    1. Buigues C, et al. The relationship between depression and frailty syndrome: a systematic review. Aging Ment. Health. 2015;19:762–772. doi: 10.1080/13607863.2014.967174. - DOI - PubMed
    1. Daskalopoulou M, et al. Depression as a risk factor for the initial presentation of twelve cardiac, cerebrovascular, and peripheral arterial diseases: data linkage study of 1.9 million women and men. PLoS ONE. 2016;11:e0153838. doi: 10.1371/journal.pone.0153838. - DOI - PMC - PubMed
    1. Pan A, Sun Q, Okereke OI, Rexrode KM, Hu FB. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA. 2011;306:1241–1249. doi: 10.1001/jama.2011.1282. - DOI - PMC - PubMed

Publication types

MeSH terms