title: Antidepressant pharmacotherapy in old-age depression-a review and clinical approach.
abstract: OBJECTIVE
  Depression in old age is a disabling disease associated with functional and cognitive decline severely affecting quality of life. Studies specifically investigating antidepressant treatment for this special cohort of patients remain scarce and results are often conflicting. A narrative literature review was undertaken, synthesizing findings from published studies, systematic reviews, and treatment guidelines specifically conducted in elderly depressed patients to summarize implications and current recommendations as well as gaps in evidence for old-age pharmacologic treatment.
  
  
  METHODS
  PubMed and Medline databases were searched for articles from July 2011 to July 2016. Only RCTs, meta-analyses, systematic reviews, and treatment guidelines focussing on the effect of antidepressant pharmacotherapy in old-aged participants were extracted, analysed, and discussed. The search resulted in a total of 26 articles.
  
  
  RESULTS
  Selective serotonin reuptake inhibitors (SSRIs) and other second-generation antidepressants are recommended for first-line treatment of old-age depression. The differences in efficacy and tolerability within different substances and substance classes are minimal or non-existent. Tricyclic antidepressants (TCAs) are only considered for second-line treatment, due to their cardiac risk profile and anticholinergic effects. In treatment-resistant depression, augmentation therapy options include lithium and atypical antipsychotics.
  
  
  CONCLUSIONS
  There is convincing evidence that antidepressants are efficacious in the treatment of old-age depression and that rationales are necessary for treatment planning. However, evidence-based data on recovery and remission rates in old-age depression specific to certain antidepressant drugs are still missing in trials and are of great importance for pharmacological treatment of old-age depression in daily clinical practice.
authors.affiliation: Allgemeine Psychiatrische Abteilung, Krankenanstalt Rudolfstiftung, Juchgasse 22, 1030, Wien, Austria.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Pruckner
authors.affiliation: Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer Krankenhaus Hedwigshöhe, Höhensteig 1, 12526, Berlin, Germany. V.Holthoff-Detto@alexianer.de.|Faculty of Medicine, University of Technology Dresden, Dresden, Germany. V.Holthoff-Detto@alexianer.de.
authors.forename: Vjera
authors.initials: V
authors.lastname: Holthoff-Detto
mesh_terms: D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000008:administration & dosage; D003863:Depression / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D006801:Humans; D018020:Lithium Compounds / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds
keywords: Antidepressant pharmacotherapy; Depression; Old age