Treatment is effective in about 80% of identified cases, when treatment is provided. Effective management requires a biopsychosocial approach, combining pharmacotherapy and psychotherapy. Therapy generally results in improved quality of<unk> , enhanced functional capacity, possible improvement in medical health status, increased longevity, and lower health care costs. Improvement should be evident as early as two weeks after the start of therapy, but full therapeutic effects may require several months of treatment. Therapy for older patients should be continued for longer periods than are typically used in younger patients. Psychotherapy Psychologic therapies are recommended for elderly patients with depression because of this group's vulnerability to adverse effects and high rates of medical problems and medication use. Psychotherapeutic approaches include cognitive behavioral therapy, supportive psychotherapy, problem-solving therapy, and interpersonal therapy.<unk>  review therapy is another type of therapy with evidence supporting its usefulness in older adults with moderate depression. The potential benefit of psychotherapy is not diminished by increasing age. Older adults often have better treatment compliance, lower dropout rates, and more positive responses to psychotherapy than younger patients. While therapy can be beneficial, it is not always provided due to factors such as lack of trained therapists or lack of coverage by health insurance. Pharmacotherapy Pharmacotherapy for acute episodes of depression usually is effective and free of complications. Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. The most promising therapeutic effect is achieved when the treatment continues for at least six weeks. Underuse or misuse of antidepressants and prescribing inadequate dosages are the most common mistakes physicians make when treating elderly patients for depression. Only 10% to 40% of depressed elderly patients are given medication. Selective serotonin reuptake inhibitors, commonly referred to as SSRIs, are considered first line pharmacotherapy for depression in<unk> <unk>  as they are more tolerable and safer than other antidepressants. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered second-line but also can be useful for patients suffering from chronic pain. Atypical antidepressants such as bupropion and mirtazapine have not been studied extensively in older adults but appear to offer some benefit. Monoamine oxidase inhibitors (MAOIs) similarly have been shown to offer some benefit, but have not been studied extensively MAOIs must be used with caution to prevent side effects such as serotonin syndrome and adrenergic crisis. Tricyclic antidepressants are no longer the first line therapy for depression, but can still benefit patients who do not respond to initial therapies. TCAs have also demonstrated a unique ability to prevent re-occurrence of depression following electroconvulsive therapy. TCAs are typically not used initially due to their side effects and risk from overdose compared to SSRIs. A TCA overdose can be fatal at a much lower dose than SSRIs. Antidepressants, in general, may also work by playing a neuroprotective role in how they relieve anxiety and depression. It's thought that antidepressants may increase the effects of brain receptors that help nerve cells keep sensitivity to glutamate which is an organic compound of a nonessential amino acid. This increased support of nerve cells lowers glutamate sensitivity, providing protection against the glutamate overwhelming and exciting key brain areas related to depression. Although antidepressants may not cure depression, they can lead to remission, which is the disappearance or nearly complete reduction of depression symptoms. Continuation and maintenance treatments for depression in older people A 2016 Cochrane review provided limited evidence that continuing antidepressant medication for one year seems to reduce the risk of depression recurrence with no additional harm. However, a robust recommendation can not be drawn about psychological treatments or combination treatments in preventing recurrence. Neurostimulation Neurostimulation, specifically electroconvulsive therapy (ECT) is an effective treatment for depression in the elderly. It is particularly useful in treating severe major depression that does not respond well to the above treatments. In the geriatric population specifically, including patients over the age of 85, ECT provides a safe and effective treatment option. Compared to treatment with younger patients, ECT appears to work more effectively in the older patients. A typical course of ECT treatment ranges from 6 to 12 treatments, with some requiring more or less. A normal treatment schedule in the United States might include three treatments a week on Monday, Wednesday, and Friday. Two treatments a week compares favorably with three and can also be used. Maintenance ECT, which is ECT given longitudinally after the initial set of acute treatments, also helps depression in<unk> <unk>  and helps prevent reoccurring depression. If an older person requires hospitalization for their depression, ECT has been shown in multiple studies to work faster than medicine and reduce mortality associated with depression. Even in cases such as depression following a stroke, ECT can be efficacious; however, the evidence is not as strong on its ability to treat vascular depression caused by long-term disease, versus an acute event like a stroke. Transcranial magnetic stimulation (TMS) is another example of neurostimulation used to treat depression, but ECT is considered to be the more effective modality.
Late life depression
Depression 
Retarded depression
Double depression
Treatment-resistant depression
Outline of bipolar disorder
Depression in childhood and adolescence
Personality pathology