Jennifer Pike, PhD, Neuropsychiatric Institute, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), CA, USA.
Michael Irwin, MD, Cousins Center for Psychoneuroimmunology, Neuropsychiatric Institute,
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), CA, USA.
Depressive disorders are common in the geriatric primary care setting,1 and are associated with considerable costs and human suffering.2-4 In 1990, depression was ranked as the fourth leading cause of disability worldwide,5 with annual health care costs estimated at $44 billion in the United States alone. Much of this cost is a reflection of higher health care utilization rates in depressed individuals, irrespective of medical comorbidity and mental health visits.3
The prevalence of depressive disorders, defined by the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; Table 1), in the elderly is high and ranges from 6.5-17% in the primary care setting.1,6 The rates for dysthymia, minor depression or subsyndromal depressions are roughly double those for major depression. The functional impairments and medical burden of these minor depressed geriatric patients are comparable to those of younger patients with major depression.