The evidence that newer drugs are much better than the old is thin

Depression is common in elderly people. Old people are at greater risk of developing adverse events while taking any medication—including antidepressants—because of concurrent illness, consumption of other prescribed and over the counter drugs, dose miscalculation because of forgetfulness, and altered drug kinetics.1 The efficacy and safety of antidepressants in elderly people is therefore an important treatment issue. In all age groups the use of tricyclic antidepressants for depression has been declining in favour of serotonin reuptake inhibitors.2 Although views differ on whether serotonin reuptake inhibitors should be used as first line treatment in depression,3 the drop out rates from treatment are similar for both classes of drug—about a third in each group.4 What is the evidence for efficacy and safety of serotonin reuptake inhibitors and other newer classes of antidepressants drugs inelderly depressed patients?

Newer, non-tricyclic antidepressants are often claimed to be as effective as but …