[Depression in the aged: diagnosis and treatment].
DIAGNOSIS: Recently published research has provided new elements for longstanding questions concerning depression in the elderly. The wide differences in epidemiological data are largely due to differences in the population studied and age-related changes in lifestyle. The relative proportions of syndromic and infra-syndromic states of depression appear to be different in young adults and elderly adults. In addition, it has been demonstrated that non-specialized criteria cannot correctly identify depressive disorders in the elderly. Many different specific evaluation tools have been developed, but often the available instruments used are poorly adapted to the elderly. IN CLINICAL PRACTICE: Clinically, it is possible to distinguish between signs of depression, for example depressive states with a cognition dysfunction component and early phases of dementia, and normal manifestations of the aging process. Somatic signs lack specificity but rarely compromise diagnosis. Although the relationship between somatic signs and depression in the elderly is complex, our understanding is improving constantly. Unlike official taxonomies, certain authors describe geriatric depression as a nosologically distinct entity. TREATMENT: The probably underestimated need for treatment is directly related to prognosis. Treatment should include a psychotherapy component and a drug component. New better tolerated and less toxic antidepressors appear to be as effective as tricyclics and their derivatives. There is some concern however about side effects. Current research will determine whether they are as frequent as with the reference treatments. 10 ANTIDEPRESSORS: We discuss published data on 10 available antidepressors proposed for geriatric patients (viloxazine, mianserine, tianeptine, fluoxetine, moclobemide, paroxetine, citalopram, sertraline, minalcipran, venlafaxine).