Objectives. To examine general practitioners' (GP) awareness of depression in their elderly patients (aged over 65) and to identify characteristics of those patients least likely to be recognized and treated.Design. A cross-sectional study comparing the clinical opinion of the GP with assessment of mental state using a validated interview schedule (the Short Comprehensive Assessment and Referral Evaluation).Setting and subjects. 510 elderly residents in the Gospel Oak area of Camden in North London registered with 28 GPs at 13 practices.Main outcome measures. Agreement between GP view and patient interview. Evidence of active management measured by examining GP records for appointments, referrals and prescription of psychotropic mediation.Results. GPs were aware of depression in 36 (51%) of 70 depressed patients. Those least likely to be recognized were men, the married, those with high levels of physical handicap, those suering from visual impairment and those who were least well educated. Of the 32 patients believed to be depressed, 12 (38%) were prescribed antidepressant medication and/or referred to mental health/social services.Conclusions. Levels of recognition of depression were lower than other recent reports. These ®ndings may re¯ect the continued debate about the most suitable management of the elderly depressed in primary care and stress the need for further evaluation of appropriate treatment strategies for this group.