A systematic approach to pharmacotherapy for geriatric major depression

Clin Geriatr Med. 2014 Aug;30(3):517-34. doi: 10.1016/j.cger.2014.05.002. Epub 2014 Jun 14.


The broadening use of antidepressants among older Americans has not been associated with a notable decrease in the burden of geriatric depression. This article, based on a selective review of the literature, explores several explanations for this paradox. The authors propose that the effectiveness of antidepressants depends in large part on the way they are used. Evidence supports that antidepressant pharmacotherapy leads to better outcomes when guided by a treatment algorithm as opposed to attempting to individualize treatment. Several published guidelines and pharmacotherapy algorithms developed for the treatment of geriatric depression are reviewed, and an updated algorithm proposed.

Keywords: Algorithm; Antidepressant agents; Drug therapy; Geriatrics; Guidelines; Major depressive disorder; Old age; Stepped care.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Aged
  • Algorithms*
  • Antidepressive Agents / therapeutic use*
  • Depressive Disorder, Major / drug therapy*
  • Humans
  • Practice Guidelines as Topic*


  • Antidepressive Agents