Depressive disorders are the most common psychiatric illness in the elderly. All tricyclic antidepressants show comparable therapeutic efficacy, thus the choice of drug is based on their side effects profiles rather than on degree of therapeutic efficacy. The secondary amines nortriptyline and desipramine are drugs of choice for the elderly depressive patient because of their relatively mild side effects profile. New-generation antidepressants remain second choice. Patients suffering from a psychotic depression often require a combination of an antidepressant drug with an antipsychotic drug. Addition of lithium to a cyclic antidepressant can produce a rapid and lasting remission in patients with a major depressive disorder who do not respond to a cyclic antidepressant alone. Treatment with MAO-inhibitors or electroconvulsive therapy can also be considered in refractory cases.