What are the key considerations for prescribing antidepressants in older adults?

When prescribing antidepressants in older adults, key considerations include taking into account the person's general physical health, existing comorbidities, and potential interactions with other medications they are taking. Careful monitoring for side effects is essential, with particular vigilance for an increased risk of falls and fractures. Additionally, clinicians should be alert to the risk of hyponatraemia, especially in those with other risk factors such as concomitant use of diuretics. Lithium augmentation requires specific monitoring of renal, thyroid, and calcium levels before and during treatment, with dose adjustments based on serum lithium levels and clinical response. The choice of antidepressant should consider safety profiles, tolerability, and the potential for drug interactions, with selective serotonin reuptake inhibitors (SSRIs) often preferred due to their safety. Regular review and monitoring are important to manage side effects and ensure treatment efficacy in this population.