In this review the course of depression in elderly patients treated at psychiatric in- or outpatient clinics is compared to results of studies carried out among community- dwelling elderly. With psychiatric treatment 50%-80% of elderly depressed patients have a favourable response. A considerable percentage of patients relapses, of which most recover with treatment. Comparing the findings of 15 studies, employing global criteria, a favourable long term course can be expected in about 50%-60% of treated elderly patients. Physical illness, the duration and severity of the index-episode, age at onset, and comorbid cognitive and personality disorders appear to be predictors of the course. All other variables studied either have no association with the course, or show equivocal results. In community based studies the course of depression appears to be less favourable than among patients treated at psychiatric services. Using 10 criteria, methodological shortcomings of the available studies are elaborated on. In the conclusions section the relevance of these findings for clinical practice and for future research are discussed.