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Optimizing Antidepressant Therapy in Older Adults | Pharmacy QI | Mar 2021

March 2021 | Practical Tips for Quality Improvement | View PDF

Antidepressant therapy in older adults should be guided by a resident-centred approach, including: comorbidities, concurrent medications, clinical features of depression, previous antidepressant history, and renal and hepatic function. To optimize antidepressant therapy in older adults, consider the following:


Start with a low dose (e.g., 50% of the adult starting dose) and slowly titrate to a therapeutic dose.

2. WAIT 12 weeks to assess the response to antidepressant therapy.

If a partial response is observed, there are several options:

  1. Increase the antidepressant dose, if possible, to maximum dosing or tolerability;
  2. Switch to another first-line antidepressant from the same or different medication class;
  3. Initiate combination therapy, such as the use of an antidepressant with the addition of mirtazapine or bupropion with different mechanism of action and lower risk combinations for serotonin syndrome;
  4. Combine depression-specific psychotherapy with an antidepressant; or
  5. Initiate antidepressant augmentation strategies – use of lithium as an augmentation antidepressant therapy was associated with a response rate of 42%, and the use of venlafaxine with aripiprazole resulted in remission rates of 44%.

4. CONTINUE TREATMENT for 12 months from the first depressive episode, to prevent relapse.

5. CONTINUE THERAPY for another one to two years in residents with a history of two depressive episodes.

  • Continue for three years, or possibly indefinitely, for those with rapid recurrence or three or more episodes.


  1. Marvanova M, McGrane IR. Treatment Approach and Modalities for Management of Depression in Older People. Sr Care Pharm 2021;36:11-21.

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