Prescribing and deprescribing antidepressants in older adults: a case-based discussion

Antidepressants are widely used in older adults, however specific consideration of physiological changes, polypharmacy, comorbidities and risks associated with these medicines in this patient group should be reviewed before commencing or continuing treatment. This article provides an overview of the issues surrounding antidepressant use among older people and uses a case-based discussion to explore how independent prescribers can make safe, person-centred decisions when prescribing and deprescribing antidepressants for this patient group. The case example illustrates the potential challenges involved in managing cross-tapering and withdrawal of treatment in the acute hospital setting. The article highlights key considerations for physical health, including hyponatraemia and serotonin syndrome, alongside the importance of hyperbolic tapering when withdrawing treatment. It emphasises the crucial role of prescribers in decision-making, monitoring patients and collaborating with the multidisciplinary team, thereby reducing risks and supporting the well-being of patients. The article also discusses evidence-based deprescribing principles, taking into consideration resources and time constraints.