What unique factors do you take into consideration for geriatric patients with a first lifetime episode depression?

The most important in a first-lifetime MDE is ruling out vascular depression, through:

• A detailed neurological exam looking for focal pyramidal/extrapyramidal/cortical function deficits.
• Neurocognitive testing (if feasible)
• Brain imaging (preferably an MRI without contrast)

This is important for two reasons:

1. Prognostically, treatment response is expected to be lower than non-vascular depression. It helps to set expectations for the patients and their families.
2. Psychosocial interventions are a...

Late-onset depression can also be the earliest symptom of dementia, particularly Alzheimer's, in some cases!

I agree with the suggestions to check for vascular and early dementia, but a very neglected cause is hypothyroidism. This is a very common cause of depression in all ages. The internists are relatively clueless. It should be a clinical diagnosis, with labs used to guide treatment.

In Europe, a TSH >2.5 is diagnostic, and 2.0-2.5 is considered probable. Our reference ranges go up to 3.5-4+. They then Ck the level of the nearly inactive T4. It's the intracellular effect of T3 that's important. Rev...