Objective: The objective of the study is to systematically analyze and summarize research literature regarding health service use and costs of depressive symptoms in late life. Design: Relevant articles were identified by systematically searching the databases MEDLINE, Web of Science, PSYNDEXplus, PsycINFO, and Cochrane Library. Keywords were ‘depression’ or ‘depressive*’, and ‘cost’ or ‘economic burden’ or ‘utilization’ or ‘use’ and ‘old age’ or ‘elderly’. Studies based on representative samples of elderly individuals aged 55 years and older were included. Results: 55 studies were found, 34 studies determined health service utilization, 10 studies reported costs, and 11 studies reported both. Studies of health service utilization and costs showed homogeneously that depressive elderly individuals have an increased service use compared to non-depressive, and a one-third increase of outpatient, inpatient, and total healthcare costs of depressive individuals. The majority of studies reported antidepressant (AD) use between 20 and 45% by depressive individuals. Mean annual costs for AD ranged from 108 to 305 US$ PPP (purchasing power parities). Increased service use and costs are only to a small proportion related to depression treatment. Conclusions: Depressive symptoms in late life lead to a high economic burden for nations which is not explained by costs for depressive symptom treatment. Strategies for improvement of diagnostic validity and treatment success of depressive symptoms in late life may have an effect on economic burden for societies.