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The empathic connection when treating older people cannot be overstated.

Teasing apart symptoms to determine if they're signs of depression or dementia requires a full consultation.

The result of not detecting or treating depression can be devastating.

The relational aspect of working with older patients cannot, in my experience, be overstated. When seniors start psychotherapy, they are almost always eager to use their time productively and, have a lot to say. They have lived through painful emotional experiences, illness, family and financial difficulties, and loss. Many have never set aside time to share and explore their feelings and memories. Frequently, they live alone, feel isolated, and are especially appreciative of the psychotherapeutic opportunity.

It's hardly a surprise that a good doctor-patient relationship is key to successful treatment. But with the emphasis today, in the increasingly corporatized medical industry, on increasing the volume of patients one sees, medical appointments are often brief and businesslike. And while the signs and symptoms of depression can be very clear in a younger person, with someone who is elderly, teasing apart what is causing their problems requires a bit of detective work.

Before bringing in her mother to see me, Nancy, her adult daughter, told me, "I don't know what's going on with my mom. Until a few years ago, she was calm, organized, and thoughtful. Now she's an anxious, irritable, indecisive old lady," Nancy said. "Sometimes I think she's losing it. At other........

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