AHRQ: Adverse Effects of Pharmacological Treatments of Major Depression in Older Adults (3/19)

By AHRQ - April 02, 2019

Purpose of Review

To assess adverse events of antidepressants in the treatment of major depressive disorder in adults 65 years of age or older.

Key Messages

In people 65 years of age or older:

  • Serotonin norepinephrine reuptake inhibitors (SNRIs) (duloxetine and venlafaxine) cause adverse events more often than placebo and most likely lead to discontinuation of therapy during treatment of up to 12 weeks.
  • Selective serotonin reuptake inhibitors (SSRIs) (escitalopram and fluoxetine) most likely cause adverse events at a similar frequency to placebo therapy but still may lead to discontinuation of therapy during treatment of up to 12 weeks.
  • Duloxetine most likely increases the risk of falls over longer treatment (<24 weeks)
  • Adverse events contributing to discontinuation of therapy were rarely reported in a way that allowed clear characterization of what adverse events to expect.
  • Few studies compared other antidepressants to placebo or to each other, or reported other outcomes. Trial data were sparse, and trials were short in duration, underpowered, and studied low doses of antidepressants. Observational studies had limitations related to their design. Long-term, rigorous comparative studies are needed.