Clinical considerations of antidepressant prescribing for older patients

Depression may affect up to 50% of people in older age groups. The increasing numbers of patients over 65 years of age may lead to higher prevalence rates of this debilitating condition. The diagnosis of depression in older patients is complex because symptoms may present as somatic concerns or anxiety. Comorbid conditions need to be investigated, evaluated and, if necessary, treated. Prescribing antidepressants to older patients requires consideration of the pharmacokinetic parameters of the medications used in this population, as these affect drug selection, duration of treatment, and suitability when comorbidity is present. This paper provides a review of current literature and makes recommendations for the pharmacological management of depression in older patients within the New Zealand context.