A generation ago, geriatric depression was regarded as either a natural reaction to the privations and multiple losses that accompany old age, or an irreversible consequence of cerebral degeneration heralding a dementia. Even if physicians overcame their expectation of the inevitability of depression in old age, an unhealthy nihilism concerning the effects of antidepressant treatment in this group held sway (Ford & Sbordone, 1980). Because Freud had taught that patients over the age of 45 years were resistant to change in psychoanalysis, even talking therapies were closed to this group. There is an inescapable irony in that Freud was himself in his 40s when he took this position—now regarded as not only ageist but essentially untrue (Jarvik & Small, 1989).