Editorial

In the UK, one of the strategic aims for the health services is to reduce death by suicide. Older people are over-represented in national suicide figures in most developed countries so they are de facto a high risk group. For example, in the UK, people aged over 65 comprise about 15% of the population but this age group accounts for between 20 and 25% of all completed suicides.

There seems reasonable, if depressing, agreement from studies of mixed aged subjects and elderly subjects in psychiatric settings that nonresponse or poor response to a course of an antidepressant occurs in at least one-third of depressed patients. The figure may be higher in elderly patients in general and those with poor physical health. The human cost of chronic depression is highlighted in the Medical Outcomes Study. The level of functional impairment and intereference with quality of life associated with depression was comparable with or worse than that of eight major chronic medical conditions, including diabetes, arthritis and severe coronary artery disease. The final tragedy for unremitting depression may of course be suicide.