Antidepressants and older adults

This edition of check equips general practitioners with the knowledge and tools to review antidepressant use effectively to enhance patient safety and improve outcomes for older adults, ensuring that treatment aligns with best-practice guidelines and individual patient needs.

Mental health conditions, including depression and anxiety, affect millions of Australians and are increasing in prevalence because of a range of social, economic and environmental factors. While these challenges can affect individuals across all age groups, they often present unique complexities in older adults (≥65 years, or ≥50 years for Aboriginal and Torres Strait Islander peoples), where depression and anxiety frequently intersect with issues such as chronic illness, cognitive decline, grief, loss and social isolation.

Managing these conditions in older adults requires careful consideration. Clinical guidelines generally encourage prioritising non-pharmacological strategies over pharmacological treatments, which is important given the modest and variable efficacy of antidepressants in this age group, along with their potential risks. Despite this, recent data from the Australian Institute of Health and Welfare indicate that approximately one in four Australians aged over 65 years were prescribed antidepressants in 2022–2023, compared with one in seven across the general population. This prescribing rate is striking, especially given that older adults report lower rates of depression and anxiety than younger cohorts. It underscores the importance of critically assessing antidepressant use in older adults. While these medications can play an important role in certain circumstances, their prolonged use – averaging four years in Australia – often exceeds guideline recommendations. Extended use is associated with risks such as hyponatraemia, gastrointestinal bleeding, sexual dysfunction, weight gain, falls, fractures and even increased all-cause mortality, especially in those with multiple chronic conditions.

This activity addresses the critical need to support general practitioners in optimising the management of antidepressants in older adults, particularly in reviewing long-term use and deprescribing where appropriate. Deprescribing, while essential to reducing unnecessary medication risks, often involves challenges, including concerns about withdrawal symptoms, relapse and the complexity of tapering doses. Social and clinical contexts can also contribute to an over-reliance on pharmacological treatments, with alternatives such as exercise, psychological therapies and social interventions often underutilised in practice.

By equipping general practitioners with the knowledge and tools to review antidepressant use effectively, this activity aims to enhance patient safety and improve outcomes for older adults, ensuring that treatment aligns with best-practice guidelines and individual patient needs.

Learning outcomes

At the end of this activity, participants will be able to:

• identify key factors that influence the diagnosis and management of depression or anxiety in older adults
• apply shared decision-making approaches when discussing treatment options for depression or anxiety with patients
• assess the evidence for effectiveness and consider the risks associated with prescribing antidepressants for older adults
• implement individualised management plans for depression or anxiety that include non-pharmacological strategies and treatment goals and address patient expectations
• establish processes for regular review and monitoring of older adult patients with depression or anxiety to optimise management, minimise potential harms and support deprescribing, if needed.

Case studies