title: A systematic approach to pharmacotherapy for geriatric major depression.
abstract: The broadening use of antidepressants among older Americans has not been associated with a notable decrease in the burden of geriatric depression. This article, based on a selective review of the literature, explores several explanations for this paradox. The authors propose that the effectiveness of antidepressants depends in large part on the way they are used. Evidence supports that antidepressant pharmacotherapy leads to better outcomes when guided by a treatment algorithm as opposed to attempting to individualize treatment. Several published guidelines and pharmacotherapy algorithms developed for the treatment of geriatric depression are reviewed, and an updated algorithm proposed.
authors.affiliation: Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada. Electronic address: benoit.mulsant@camh.ca.
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Blumberger
authors.affiliation: Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada; Hotchkiss Brain Institute, Foothills Hospital, University of Calgary, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada.
authors.forename: Zahinoor
authors.initials: Z
authors.lastname: Ismail
authors.affiliation: Geriatric Psychiatry & ECT Program, Department of Psychiatry, The Ottawa Hospital, University of Ottawa, 75 Bruyere Street, Suite 137 Y, Ottawa, Ontario K1N 5C7, Canada.
authors.forename: Kiran
authors.initials: K
authors.lastname: Rabheru
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada; Sunnybrook Health Sciences Centre, FG37-2075 Bayview Avenue, Toronto, Ontario M4C 5N6, Canada.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Rapoport
mesh_terms: D000368:Aged; D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D017410:Practice Guidelines as Topic
chemical_list: D000928:Antidepressive Agents
keywords: Algorithm; Antidepressant agents; Drug therapy; Geriatrics; Guidelines; Major depressive disorder; Old age; Stepped care