Ageing is a long process, characterized by great heterogeneity. Depression is a disease that occurs frequently in the last stages of life but with a set of symptoms often unclear and this condition makes an early diagnosis difficult sometimes. Depressed mood is not usually the first symptom shown by the patient, substituted instead by somatic complaints, insomnia, fatigue, poor memory or bizarre symptoms. The evaluation of biological, psychological and socio-environmental conditions is also important in the diagnosis process and also in any prognosis in the elderly. In this article the presentation of two clinical cases gives the opportunity to reflect on psychotherapy in the elderly. The first is a woman of 76 years old, with depression and perceptual alterations; the second one is an 87 year old man with problems of anxiety and depression. For both the intervention plan, provided weekly individual sessions. With an "old old" patient, it can promote ways of distancing to differentiate between objective and subjective reality, and between facts and interpretation. With the "oldest old" patient the project involves limited objectives and more direct strategies, with the aim of improving as much as possible the quality of life. Last but not the least, the role of the psychotherapist who must develop awareness, flexibility and creativity to compensate for the difficulty of identification with a patient who proposes issues and problems often far from their age and experience.
Keywords: Depression, aging, psychotherapy.