Pharmacotherapy of late-life depression: Evidence-based recommendations

Abstract

Antidepressant medications are the most thoroughly researched and most frequently employed modality for treating late-life depression. Though their benefits have repeatedly been shown superior to those of placebo in treating depressed elderly research subjects, many questions about their use in clinical populations remain unresolved. Which of the many available antidepressants should be chosen initially? Are there strong differences between classes or between agents within a class? How should treatment approaches be modified in the care of special populations of depressed elderly such as those with, dementia, psychotic depression, or treatment resistance? How long should the acute and continuation phases of a treatment trial be extended? Under what circumstances and for how long should maintenance treatment be prescribed? And, finally, what gaps are there in our knowledge to guide the design and implementation of more-informative future studies? This chapter will briefly review antidepressants, then address the issues relevant to the special needs of elderly depressed patients by reviewing the available evidence base for treatment decisions regarding the pharmacotherapy of late-life depression.