Current pharmacological approaches and perspectives in the treatment of geriatric mood disorders Breno S. Diniz, Paula V. Nunes, Rodrigo Machado-Vieiraand Orestes V. Forlenza Introduction Affective disorders are common and disabling psychiatric conditions in the elderly. Depressive disorders, including major depression, dysthymia and subsyndromal depres- sion occur in up to 40% of community-dwelling elderly individuals [1,2]. Bipolar disorder in the elderly is much less common than depression and is estimated to affect 0.5–1% of the elderly population [3,4]. Untreated affective episodes are associated with short and long-term negative consequences in the elderly. These include higher prevalence of medical comorbidities, higher mortality, increased suicide risk, worsening of qual- ity of life, loss of productivity, cognitive impairment, functional decline and structural brain changes [5–8]. Most of these deleterious consequences may be prevented with successful treatment of the affective episode [9,10]. In this work, we review recent advances in the pharma- cological treatment during acute and maintenance phases of depression and bipolar disorder in the elderly. Pharmacological treatment of major depression The treatment of major depression has been considered a major challenge in psychogeriatric practice. The main goals of antidepressant treatment are to achieve remission of depressive symptoms, to prevent relapse and recur- rence of depressive episode and to yield functional recovery. Treatment outcomes rely on several factors, including an appropriate diagnostic assessment that includes the identification and management of comor- bidities, and underlying psychosocial factors, which impact on the correct choice of available treatment options and resources [11]. In the last few years, new studies have focused on the development of strategies to increase remission rates during the acute treatment phase, as well as to maintain the antidepressant response in the maintenance phase. Also, the studies aim to identify predictors of antidepressant response. Selective serotonin reuptake inhibitors (SSRIs) remain the first choice for the pharmacological treatment of major depression in the elderly [12]. These agents are as effective as tricyclic antidepressants, but are safer and more tolerable [13,14]. Nonetheless, a large proportion of elderly patients experience only partial response to antidepressant treatment alone and few (<30%) show full remission [15  ]. Persistence of residual depressive symptoms during antidepressant treatment is common [16  ] and has been associated with higher risk of relapse and recurrence [17]. Therefore, new effective pharma- cological approaches are expected to induce full Laboratory of Neuroscience, Department and Institute of Psychiatry, Faculty of Medicine, University of Sa ˜o Paulo, Sa ˜ o Paulo, Brazil Correspondence to Breno S. Diniz, Rua dr. Ovidio Pires de Campos, 785, 3rd floor, Pinheiros, CEP 05403-010, Sa ˜ o Paulo, Brazil Tel: +55 11 3069 7267; e-mail: brenosatler@usp.br Current Opinion in Psychiatry 2011, 24:473–477 Purpose of review This work aims to review the most recent developments in the treatment of mood disorders (major depression and bipolar disorder) in the elderly. Recent findings In the last years, few new pharmacological interventions for mood disorders have been developed. Recent studies seek to provide alternative treatment strategies to achieve higher remission rates, including the association of antidepressants, mood stabilizers and psychotherapy and the treatment of specific clusters of symptoms, such as the adjunctive treatment of cognitive impairment with cholinesterase inhibitors. Also, recent studies have been assessing the potential of pharmacogenetic information in the prediction of treatment outcomes. Summary These factors altogether are expected to help the development of personalized treatment strategies that may improve outcomes with fewer adverse effects. Keywords antidepressants, bipolar disorder, major depression, mood disorders, mood stabilizers, treatment Curr Opin Psychiatry 24:473–477 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 0951-7367 0951-7367 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/YCO.0b013e32834bb9bd