Background: Blood lipids are widely used in monitoring the risk of cardiovascular diseases; however, atherogenic indices are more precise markers. The aim of the study was to determine differences in atherogenic indices in elderly patients with unipolar depression (DEP) compared with nondepressed elderly patients (nonDEP) using case-control analysis.Methods: Fasting serum lipid profiles were measured in 564 (depressed: n = 282, nondepressed: n = 282, 83. 7% (n = 236) women in both groups) Caucasian inpatients aged ≥60, with mean age 76.9 years. Patients from both groups were matched for age and sex. Atherogenic index of plasma (AIP) was calculated as log(triglycerides/HDL cholesterol). Castelli atherogenic indices were calculated as follows: AI is the ratio of low-density lipoprotein (LDL) cholesterol to high-density lipoprotein (HDL) cholesterol and AI is the ratio of total cholesterol to HDL cholesterol.Results: HDL levels were significantly decreased in depressed patients (48.2 ± 14.4 mg/dL vs. 54.5 ± 17.7 mg/dL). No other differences in lipid profile were found. We found that all three analyzed atherogenic indices were increased in depressed patients (AIP: 0.41 ± 0.28 vs. 0.33 ± 0.27, AI: 2.90 ± 1.41 vs. 2.42 ± 1.07, AI: 4.51 ± 1.84 vs. 3.79 ± 1.21). We found associations between depression severity and reduced level of HDL (β = -0.02) or increased AIP (β = 1.66).Conclusions: All three atherogenic indices were increased in elderly patients with depression. Since depression and age are associated with elevated risk of cardiovascular events, elderly patients with depression should be carefully monitored for abnormal lipid status to reduce their cardiovascular risk. The role of lipid abnormalities in the pathogenesis of depression requires further studies.