Drugs & Aging

, Volume 25, Issue 10, pp 841–853 | Cite as

Use of Antidepressants in Late-Life Depression

  • Tarek K. Rajji
  • Benoit H. Mulsant
  • Francis E. Lotrich
  • Cynthia Lokker
  • Charles F. ReynoldsIII
Review Article


Late-life depression (LLD) is a common and typically recurrent illness that is often unrecognized and under-treated. It is associated with significant co-morbidities and poor health outcomes. Antidepressants are typically used as a first-line treatment for LLD. We performed a systematic review of the English literature (1996 to August 2007) and present results relevant to the efficacy of antidepressants in acute and maintenance pharmacotherapy of LLD, the predictors of LLD treatment outcomes and pharmacological strategies for non-remission. There is a consensus in the literature that the goal of treatment should be remission. Although antidepressants can be categorized into several classes based on their putative mechanisms of action, there is no consistent evidence that antidepressants from different classes are associated with different rates of remission of LLD. After achieving remission, the evidence supports a beneficial role of maintenance pharmacotherapy in reducing the rate of recurrence of LLD for at least 2 years. There are reports of a number of possible augmentation and switching strategies that can be used when LLD remission is not attained. However, none of these various strategies has been studied rigorously in patients with LLD as yet. Overall, the current literature is adequate for guiding acute and maintenance pharmacotherapy of LLD but further research is urgently needed to guide clinical strategies in non-remission.



Sources of support for the preparation of this review were: US Public Health Service P30 MH71944 (Advanced Center for Interventions and Services Research in Late Life Mood Disorders), K24 MH069430, the University of Pittsburgh Medical Center endowment in Geriatric Psychiatry and the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine. The authors would like to thank Dr K. Ann McKibbon at McMaster University, Hamilton, Ontario, Canada for her contributions to the conceptualization of the review and the literature search strategy. In the past 5 years, Dr Benoit Mulsant has received grants or research support from the US National Institutes of Health, Eli Lilly, Forest, GlaxoSmithKline (GSK), Janssen and Pfizer; has received other financial or material support from Forest and Janssen; has acted as a consultant to or received honoraria from AstraZeneca, Eisai, Bristol-Myers Squibb (BMS), Forest, Fox Learning System, Janssen, Lundbeck, GSK and Pfizer; and is a current stockholder in Akzo-Nobel, Alkermes, AstraZeneca, Biogen Idec, Celsion, Elan, Eli Lilly, Forest, General Electric, Immune Response and Pfizer. Dr Charles F. Reynolds III has been the recipient of grants from Pfizer, GSK, Forest, Lilly and BMS. The other authors have no conflicts of interest that are directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Tarek K. Rajji
    • 1
    • 2
  • Benoit H. Mulsant
    • 1
    • 2
    • 3
  • Francis E. Lotrich
    • 3
  • Cynthia Lokker
    • 4
  • Charles F. ReynoldsIII
    • 3
  1. 1.Department of PsychiatryUniversity of TorontoTorontoCanada
  2. 2.Geriatric Mental Health ProgramCentre for Addiction and Mental HealthTorontoCanada
  3. 3.Department of PsychiatryUniversity of Pittsburgh Medical CenterPittsburghUSA
  4. 4.Health Information Research Unit, Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada

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