Use of SSRIs in the elderly: obvious benefits but unappreciated risks

Selective serotonin reuptake inhibitors (SSRIs) are frequently recommended as a first-line treatment for depression in elderly patients. The evidence for this recommendation appears to be weak because studies that have examined the comparative efficacy, safety, tolerability and effectiveness of SSRIs and tricyclic antidepressants (TCAs) suggest that there are few advantages for one over another. Furthermore, a number of potential adverse effects of SSRIs are unappreciated risks. These include falls, hyponatremia, weight loss, sexual dysfunction and drug interactions. These potential risks, however, appear to be equally balanced by advantages such as fewer anticholinergic effects, a benign cardiovascular profile, ease of use and safety in overdose. SSRIs and TCAs have relative risks and benefits, and clinicians must maintain expertise in prescribing for elderly patients given both the frequency and severity of depressive disorders in late life.