Mood disorders are among the most significant and often overlooked disorders in later life (Consensus Development Panel of the Depression and Bipolar Support Alliance, 2003). Because there is relatively little research on late-life bipolar disorder, this chapter will focus on depression. Depression is the most frequently diagnosed psychiatric disorder in late life (Verhey & Honig, 1997), particularly among the chronically or acutely medically ill, those in residential facilities, or community dwellers who have recently been bereaved or assumed caregiving roles (Koenig et al., 1997). The prevalence of major depression in community samples ranges from 1% to 5% (Pahkala et al., 1995) but clinically significant depressive symptoms occur more frequently (Verhey & Honig, 1997).

Barriers to effective treatment

One of the biggest barriers to effective treatment of late-life depression may be under-recognition by older adults, their families and their physicians. Late-life depression is significantly under-diagnosed (Mulsant & Ganguli, 1999), particularly in primary care settings (Harman et al., 2001), the healthcare setting used most often by older adults (Unutzer et al., 1999). Many older adults and their physicians assume that low energy, loss of interest and somatic symptoms are part of being old or physically ill, rather than symptoms of depression (Karel & Hinrichsen, 2000) (see ‘Ageing and health behaviour’). Sleep disturbance, failure to care for oneself, withdrawal from social activities, unexplained somatic complaints and hopelessness may be important clinical clues for depression (Gallo et al., 1997).