From the Guidelines
Best Antidepressant for Older Adults
The best antidepressant to initiate in older adults is a selective serotonin reuptake inhibitor (SSRI), due to its favorable side effect profile and safety [ 1 ].
- Citalopram (Celexa) and sertraline (Zoloft) are specifically highlighted as effective options with minimal side effects [ 1 ].
- These medications should be initiated at a low dosage and increased slowly, with monitoring for side effects and potential drug interactions [ 1 ].
- The dosage should be increased until an adequate response occurs or side effects emerge, with the goal of minimizing adverse effects while achieving therapeutic efficacy.
- It is crucial to consider the anticholinergic side effects of medications, making SSRIs a preferable choice for older adults, including those with Alzheimer’s disease [ 1 ].
From the FDA Drug Label
A subset of these patients who completed the randomized controlled trials (sertraline n=99, placebo n=122) were continued into a 24-week, flexible-dose, open-label, extension study. U. S. geriatric clinical studies of sertraline in major depressive disorder included 663 sertraline-treated subjects ≥65 years of age, of those, 180 were ≥75 years of age No overall differences in the pattern of adverse reactions were observed in the geriatric clinical trial subjects relative to those reported in younger subjects No overall differences in the pattern of efficacy were observed in the geriatric clinical trial subjects relative to those reported in younger subjects.
The best antidepressant to initiate in older adults is not specified in the provided drug label. The label provides information on the safety and efficacy of sertraline in geriatric patients, but it does not compare sertraline to other antidepressants or recommend it as the best option for older adults 2.
From the Research
Antidepressant Options for Older Adults
- Selective serotonin reuptake inhibitors (SSRIs) are frequently recommended as a first-line treatment for depression in elderly patients 3
- Sertraline is an effective and well-tolerated antidepressant for the treatment of major depressive disorder in patients aged ≥60 years 4
- SSRIs have similar efficacy to other antidepressants but better tolerability, making them a popular choice for elderly patients 5
Comparison of Antidepressants
- A network meta-analysis found that sertraline, paroxetine, and duloxetine were significantly better than placebo in terms of partial response 6
- Sertraline had the lowest risk of dizziness compared to other antidepressants, including duloxetine and venlafaxine 6
- A qualitative analysis of studies found that SSRIs had fewer side-effects than tricyclic antidepressants (TCAs) 7
Safety Considerations
- SSRIs can have adverse effects such as falls, hyponatremia, weight loss, sexual dysfunction, and drug interactions, which may be more pronounced in elderly patients 3, 5
- The risk of falls and fractures in elderly patients taking SSRIs is similar to that reported with use of tricyclic antidepressants 5
- Slow titration of SSRIs to recommended therapeutic doses and cautious use with other agents known to have the potential for drug interactions is recommended in elderly patients 5