Please give the approach to depression in elderly

Assess: Ask about low mood or loss of interest, symptom duration and impact on daily functioning; review physical illness, medicines, alcohol use, bereavement, isolation, support and previous depression or self-harm NICE CKS. Ask directly about suicidal thoughts, plans and intent, assess protective factors, and arrange help according to risk NICE CKS. Use a validated depression questionnaire alongside clinical assessment, assess mental state and cognition, and consider examination or investigations where indicated NICE CKS. If dementia is present, identify and monitor behavioural changes alongside depressive symptoms Teri & Logsdon 2000.

Manage: Agree a plan through shared decision-making, offering information and support and choosing active monitoring, guided self-help, psychological therapy or an antidepressant according to severity, needs and preferences NICE CKS. For mild-to-moderate depression in dementia, consider psychological treatment and do not routinely offer antidepressants unless indicated for a pre-existing mental health problem NICE CKS. Behavioural approaches can also help address behavioural changes in Alzheimer disease Teri & Logsdon 2000. If prescribing, discuss adverse effects, withdrawal and treatment duration; review comorbidities and medicines, as trazodone may cause orthostatic hypotension and somnolence more often in older people NICE CKS,SmPC Trazodone. Arrange regular follow-up to review symptoms, functioning, adherence, adverse effects and suicide risk; if improvement is inadequate, reconsider the diagnosis and treatment plan NICE CKS.