Marie Crowe, RPN, PhD, Associate Professor, Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
Sue Luty, FRANZCP, PhD, Associate Professor, Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.

Because there are particular corollaries to the treatment of depression in older adults, which include contraindications to the use of antidepressant drugs in combination with many medications, there is a need to examine nonpharmacological forms of treatment. This paper is based on a review of the literature on nonpharmacological treatments for depression in older adults. Electroconvulsive therapy has a role in severely depressed older adults because of its rapid effectiveness in life-threatening situations while psychotherapy, either on its own or in combination with antidepressants, is effective in the treatment of mild to moderate depression.
Key words: older adults, psychotherapy, depression, electroconvulsive therapy.

Kiran Rabheru, MD, CCFP, FRCP, ABPN, Physician Leader, Geriatric Psychiatry Program, Regional Mental Health Care; Chair, Division of Geriatric Psychiatry, University of Western Ontario, London, ON.

Electroconvulsive therapy (ECT) is an effective and relatively safe procedure for treating severe, treatment-refractory mood disorders in special populations, particularly in the elderly. The frail elderly are especially good candidates for ECT because they are often unresponsive to, or intolerant of, psychotropic medications. The central nervous, cardiovascular and respiratory systems require special attention during the course of ECT. With modern anesthesia techniques and careful medical management of each high-risk patient, most elderly can successfully complete a course of ECT. Obtaining informed consent for ECT from incapable patients is a challenging issue with few concrete guidelines.
Key words: electroconvulsive therapy, elderly, depression, special patient population.