While clinical trials of antidepressants may include some individuals over the age of 65, it is not clear that evidence of safety and efficacy in such subgroup analyses are reflective of this age group more broadly. The generalizability of outcome data across populations can potentially be uncertain and the comparative efficacy of different antidepressants in older adults could potentially differ than what is seen in younger populations. As well, age-related changes that affect the pharmacokinetics and pharmacodynamics of drugs can affect the safety and potential harms with antidepressants in older adults. Older adults are at increased risk of anticholinergic side effects (common to a number of antidepressant classes), and orthostatic and sedative effects. These effects can exacerbate underlying conditions such as cardiovascular disease, cognitive impairment, delirium and can increase the risk of falls and fractures.

The purpose of this Rapid Review is to summarize the evidence of clinical efficacy and harms associated with antidepressant in older adults, and guidelines regarding their use in the population.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Methods
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1 Selection of Included Studies
• APPENDIX 2 Characteristics of Included Publications
• APPENDIX 3 Critical Appraisal of Included Publications
• APPENDIX 4 Main Study Findings and Author’s Conclusions
• APPENDIX 5 Additional References of Potential Interest

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.