Table Of ContentLate-Life Depression
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LATE-LIFE
DEPRESSION
Edited by
STEVEN P. ROOSE
HAROLD A. SACKEIM
OXFORD
UNIVERSITY PRESS
2004
OXfORD
UNIVERSITY PRESS
Oxford New York
Auckland Bangkok Buenos Aires Cape Town Chennai
Dar es Salaam Delhi Hong Kong Istanbul Karachi Kolkata
Kuala Lumpar Madrid Melbourne Mexico City Mumbai Nairobi
Sao Paulo Shanghai Taipei Tokyo Toronto
Copyright © 2004 by Oxford University Press
Published by Oxford University Press, Inc.
198 Madison Avenue, New York, New York 10016
http://www.oup.org
Oxford is a registered trademark of Oxford University Press
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press
Library of Congress Cataloging-in-Publication Data
Late-life depression / edited by Steven P. Roose, Harold A. Sackeim.
p. ; cm. Includes bibliographical references and index.
ISBN 0-19-515274-3
1. Depression in old age.
2. Geriatric psychiatry.
1. Roose, Steven P., 1948- II. Sackeim, Harold A.
[DNLM: 1. Depressive Disorder—Aged.
2. Aged—psychology.
WM 171 L351 2004]
RC537.5.L38 2004 618.97'68527-dc22 2003069051
The science of medicine is a rapidly changing field. As new research and clinical experience broaden
our knowledge, changes in treatment and drug therapy do occur. The author and publisher of this work
have checked with sources believed to be reliable in their efforts to provide information that is accu-
rate and complete, and in accordance with the standards accepted at the time of publication. However,
in light of the possibility of human error or changes in the practice of medicine, neither the author, nor
the publisher, nor any other party who has been involved in the preparation or publication of this work
warrants that the information contained herein is in every respect accurate or complete. Readers are
encouraged to confirm the information contained herein with other reliable sources, and are strongly
advised to check the product information sheet provided by the pharmaceutical company for each drug
they plan to administer.
9 8 7 6 5 4 3 21
Printed in the United States of America
on acid free paper
For Liz,
Matthew and Katie Roose,
Alexander Sackeim,
and Judith Kiersky.
These are the people with whom we wish to grow old.
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Preface
Detection and treatment of depression in the elderly are of paramount importance.
The demographics are compelling: by the year 2030, over 70 million people in the
United States will be over the age of 65 years. In fact, the most rapidly growing
segment of the population is the group over the age of 85 years, whose numbers
will double in the next decade. The remarkable growth of the segment of the pop-
ulation over the age of 65 is not restricted to the United States or Europe. Indeed,
this rate of increase will be equaled, if not exceeded, in Africa, Asia, and South
America. Thus, disorders that are prevalent and cause significant morbidity and
mortality in older individuals will consume greater health care resources and re-
quire more intensive research.
Late-life depression is a public health problem of great concern. It is an illness
that torments individuals and their families and can frequently frustrate the best at-
tempts of the most caring and knowledgeable physicians. Given its significance, it
is notable that until now there was no textbook specifically devoted to the com-
prehensive presentation of current knowledge about this disease. We felt that there
was a compelling need for this book.
We sought out prominent scientists and clinicians expert in this field and asked
them to write a fresh chapter, critically and comprehensively reviewing the state of
knowledge about their topic. We also asked them to incorporate their own think-
ing about current theories of the illness, methodological problems endemic to the
research area, and optimal treatment of their patients. Senior authors had to agree
that they would write the chapter themselves and that it would constitute a new
effort.
For whom is this book intended? Who should find this volume relevant to their
work? Our first goal was to ensure that the volume be accessible, useful, and stim-
ulating to the clinician who strives to understand the multiple dimensions of aging
and the complexity of late-life depression and who aspires to practice evidence-
based interventions. In addition, researchers wrote this book for other researchers,
offering perspectives on where the field has been and where it should go. This is a
volume that was also prepared for educators and students, including academic fac-
ulty, clinical and research fellows, residents, and graduate students. In addition to
the review of current knowledge, each chapter illustrates how the author organizes
an often methodologically disparate and large database, critically evaluates the find-
ings, and distills justifiable conclusions.
It is our hope that the contents of this book will influence our judgment, empa-
thy, and decision making as we struggle with the most complex and important
task—the diagnosis, treatment, and understanding of the suffering patient.
New York, NY S. P. R.
New York, NY H. A. S.
vn
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Acknowledgments
Throughout our careers, we have benefited from teachers, colleagues, students, and,
most of all, patients who have taught, influenced, frustrated, and inspired us. To
all of them, far too many to mention, we are grateful. We are also grateful to Fiona
Stevens, our editor, who transformed our inchoate but strongly held opinions into
the plan for this book, and to Judith Kiersky, who formatted and reformatted the
chapters until the dawn.
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