With the increase of life expectancy the ratio of elderly people in our society also increases and consequently health problems related to old age gain more attention. The prevalence of depression does not decrease in the elderly, affective disorders in old people, however, often manifest masked by physical illness worsening the course of these somatic disorders. Elderly depression also tends to present with a peculiar clinical picture. Atypical and also only few symptoms are characteristic of depression in the elderly. Vegetative symptoms are often primary and depression in old people often manifests solely in somatic symptoms. Typical cognitive alterations and pseudodementia are also characteristic features. At the same time, typical affective symptoms of depression are often absent, and instead of psychomotor retardation, psychomotor agitation manifested as irritability or motor restlessness is frequent. In the diagnostic process depression in the elderly should be separated from somatic diseases and dementia. The correct diagnosis and treatment of depression in the elderly is very important, since old age depression does not only cause significant distress, but often leads to suicide, and in addition, it generally increases morbidity and mortality, worsens the general somatic condition of the patient and increases social isolation.