Depressive disorders are the most common psychiatric ilnesses in the elderly. Recent studies show that the long-term course of depressive disorder is even worse than previously thought. Even with an adequate therapeutic trial not more than 80% of the patients with a major depressive disorder will respond to cyclic antidepressants. Patients with a psychotic depression are markedly more unresponsive. Addition of lithium to the cyclic antidepressant can produce a rapid and lasting remission in both cases. In this article four geriatric patients who recovered after lithium-addition are begin discussed. In the discussion we come with a proposal for a treatment protocol for geriatric depressed patients.