Depression is less prevalent among older adults than among younger adults but can have serious consequences. Over half of cases represent a first onset in later life. Although suicide rates in the elderly are declining, they are still higher than in younger adults and more closely associated with depression. Depressed older adults are less likely to endorse affective symptoms and more likely to display cognitive changes, somatic symptoms, and loss of interest than are younger adults. Risk factors leading to the development of late life depression likely comprise complex interactions among genetic vulnerabilities, cognitive diathesis, age-associated neurobiological changes, and stressful events. Insomnia is an often overlooked risk factor for late life depression. We suggest that a common pathway to depression in older adults, regardless of which predisposing risks are most prominent, may be curtailment of daily activities. Accompanying self-critical thinking may exacerbate and maintain a depressed state. Offsetting the increasing prevalence of certain risk factors in late life are age-related increases in psychological resilience. Other protective factors include higher education and socioeconomic status, engagement in valued activities, and religious or spiritual involvement. Treatments including behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy, and life review/reminiscence therapy are effective but too infrequently used with older adults. Preventive interventions including education for individuals with chronic illness, behavioral activation, cognitive restructuring, problem-solving skills training, group support, and life review have also received support.

In the largest twin study to date, we confirmed that heritability for AD is high and that the same genetic factors are influential for both men and women. However, nongenetic risk factors also play an important role and might be the focus for interventions to reduce disease risk or delay disease onset.

Nightmares may be more than a marker of PTSD and hence may be important in the identification of suicidal ideation.

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This study examined whether depressive symptoms increase with age longitudinally, and it evaluated two potential sources of influence-declining health and non-health-related negative life events. Adults aged 29-93 years from the Swedish Adoption/Twin Study of Aging completed the Center for Epidemiologic Studies-Depression scale three times at 3-year intervals. Analyses were performed on one twin (n = 877) and repeated on the second twin (n = 909) as a nonindependent replication. Depressive symptoms increased modestly with age in both men and women, particularly in the older participants. Health status was correlated with depressive symptoms, but new illnesses in the previous 3 years did not consistently predict increases in depressive symptoms longitudinally. Negative life events in the previous 3 years predicted depressive symptoms. Notably, depressive symptoms also predicted future negative life events.