Clinical depression in community-dwelling elderly has been estimated to be as high as 13%. Depression is frequently seen in the typical geriatric scenario of concurrent medical illness, and the suicide rate among the elderly is disproportionately higher than other age groups. Recognizing depression in the typical geriatric setting of multiple medical problems and differentiating it from other psychologic disorders is discussed in this review, as is an approach to assessing suicidal potential. An enlightened approach to drug therapy is presented, incorporating knowledge of previous treatment response and anticipating therapeutic benefits and side effects in the individual patient. An update on electroconvulsive therapy, particularly in severe geriatric depression, is included.