Outcome measures will necessarily extend beyond symptomatology to include function, disability, morbidity, mortality, health care and other resource use, family burden, institutionalization, and quality of life. Development

of preventive interventions Given the breadth and depth of the knowledge base regarding depression in late life, a clear opportunity is now presented to mount an initiative directed toward prevention. Prevention has many aspects. An intervention may be based on models of pathophysiology or etiology to prevent onset of the illness. Vascular depression presents one such opportunity, as does the research on bereavement77-79 and a variety of comorbidities, such as vision or hearing Inhibitors,research,lifescience,medical loss and other illnesses. In the context of Inhibitors,research,lifescience,medical treatment, preventive interventions may well be directed at relapse, recurrence, or excessive levels of functional disability. Safety and consumer protection As part of a public health

mission, we must also attend to issues of safety and consumer protection. For example, the widespread use of over-the-counter, unregulated treatments needs to be carefully examined for possible benefit and for potential harm. Use of complementary and alternative approaches is very high and growing.80,81 Even in patients volunteering for participation in clinical drug trials, use of herbal medications is substantial; in a series Inhibitors,research,lifescience,medical of 150 such subjects,82 56% reported having Inhibitors,research,lifescience,medical used herbs in the last month. It is therefore incumbent upon us to evaluate these treatments including natural products such as St John’s Wort or kava, psychophysiologic approaches such as eye movement desensitization reprocessing (EMDR), and somatic approaches such as acupuncture, if for no other reason than that our patients are using these in large, uncontrolled, natural experiments. Dissemination A final priority Inhibitors,research,lifescience,medical must be dissemination. Our patients are not helped by treatments that are hepatocellular carcinoma available in only in scientific journals. A recent example highlights the problem. Lehman and Steinwachs83

report that fewer than half the patients with schizophrenia in the United States received a level of care that was consistent Drug_discovery with the current state of the art. This is an important finding that cannot be ignored. As a field we must take on the challenge of translating our research into practice and placing the most powerful clinical tools in the hands of patients, their families, and the clinicians that take care of them. The Geriatric Psychiatry Alliance initiatives on depression84 represent an important and potentially valuable approach to this problem. Conclusions There has been significant progress in our selleck chemical Brefeldin A understanding of the nature, clinical course, and treatment of depression in late life. Important findings have emerged in a number of areas directly affecting clinical care and have, in turn, stimulated further research.