The psychopharmacologic treatment of depression in elders

Elders are at risk for depression from a variety of causes. Declining physical health or medical condition, loss of friends and family, adjustment to retirement, medication interactions or side effects, or a major depressive episode are possible causes of depression. The antidepressants available include TCAs, MAOIs, SSRIs, and the newer atypical medications. The selection of the appropriate drug for the particular person should be based on prior successful treatment with the medication, family history, medical conditions, and other medications. Side effects may be dose-related and must be closely monitored; they can be unpleasant and dangerous. "Start low and go slow" is the best practice for dosing antidepressants in elders. Nursing concerns include assessing and monitoring physical, emotional, and social changes, and patient and family education.