There seems reasonable, if depressing, agreement from studies of mixed aged subjects and elderly subjects in psychiatric settings that nonresponse or poor response to a course of an antidepressant occurs in at least one-third of depressed patients. The figure may be higher in elderly patients in general and those with poor physical health. The human cost of chronic depression is highlighted in the Medical Outcomes Study. The level of functional impairment and intereference with quality of life associated with depression was comparable with or worse than that of eight major chronic medical conditions, including diabetes, arthritis and severe coronary artery disease. The final tragedy for unremitting depression may of course be suicide.

This paper updates a previous review of the topic published in this series in 1992. There are no major advances in knowledge, understanding or treatment to report, but there has been a steady growth in interest, articles, chapters and textbooks dealing with neurotic disorders in the elderly, which is an encouraging sign that these common, disabling and treatable conditions are now being taken more seriously by health professionals.