New Drugs for Old Folks: The Evidence‐Based Argument for Newer Antidepressants

QUESTION: What are the comparative benefits and drawbacks of the newer medicinal and botanical therapies for depression? BACKGROUND: Depressive symptoms and disorders are prevalent and one of the leading causes of disability worldwide. The first generation of antidepressants, the tricyclic agents and monoamine oxidase inhibitors, represented a major therapeutic advance. Nonetheless, dangerous side effects and potential lethality in overdose limited their use. Seniors with a clinically significant level of depressive symptoms were more likely to receive a benzodiazepine than an antidepressant. Difficulty distinguishing depression from self‐limiting reactions to acute illness and injury also kept the generalist's threshold for prescribing an antidepressant high. The introduction and proliferation of selective serotonin reuptake inhibitors for the treatment of depression promised a golden era of psychopharmacology similar to that previously experienced with the pharmacotherapy of cardiovascular disease. However, further data on recurrence rates, the frequency with whi