Suicide has reached epidemic proportions in the elderly, particularly in non-Hispanic white men. Unfortunately, the risk is underappreciated in this population. Known risk correlates for suicide in this population fall into three interrelated categories. Sociologic factors include such considerations as living alone and having few social interactions. Physical health factors include having more medical comorbidity and being a current smoker. The mental health risk factors include the presence of mood and
anxiety disorders with a focus on the greater severity of symptoms, especially
hypersomnia, hopelessness, and a history of suicide attempts. Suicide is a spectrum comprising ideation, intent, and plan. Clinical depression is never a normal part of aging and warrants aggressive treatment. Recent warnings linking
antidepressants and suicide may have special relevance in the elderly. Based on preliminary studies with
antipsychotic drugs, a subgroup of patients who experience
akathisia may be particularly vulnerable to suicide. Upon initiation of
antidepressants, it is recommended that adults be seen in follow-up three times within the first 12 weeks of treatment; if medically indicated, the first contact should be during the first week.