What unique factors do you take into consideration for geriatric patients with a first lifetime episode depression?  

Late-onset depression can also be the earliest symptom of dementia, particularly Alzheimer's, in some cases!

The most important in a first-lifetime MDE is ruling out vascular depression, through: A detailed neurological exam looking for focal pyramidal/extrapyramidal/cortical function deficits. Neurocognitive testing (if feasible) Brain imaging (preferably an MRI without contrast) This is important...

I agree with the suggestions to check for vascular and early dementia, but a very neglected cause is hypothyroidism. This is a very common cause of depression in all ages. The internists are relatively clueless. It should be a clinical diagnosis, with labs used to guide treatment. In Europe, a TSH ...