Abstract

Depression is among the most disabling chronic disorders, and its prevalence appears to increase with age. Elderly depressed patients differ from younger adults with depression in many ways, such as the presence of multimorbidity, complex treatment regimens, reduced mobility, chronic pain, cognitive decline, social isolation and loneliness, and physiological changes in almost all organs. Antidepressants are the first-line treatment for depression in any age. While all antidepressants have similar efficacy in younger adults, elderly individuals might respond differently to particular ones. Elderly individuals are highly vulnerable to adverse events and to both pharmacodynamics and pharmacokinetic drugdrug interactions. Therefore, careful choice of antidepressant, slow dose-titration, and the lowest effective maintenance dose, with close monitoring for potential adversities, are essential. Treatment of depression in older age is a major challenge. Given the substantial clinical heterogeneity of clinical presentations and comorbid conditions, more high-quality studies are needed in selected subpopulations, while an individualized approach remains a high priority.