What considerations are important when selecting antidepressants for older adults?

• A. Hyponatremia risk, polypharmacy, falls risk, cognitive effects, tolerability.
• B. Only choose antidepressants by mood improvement speed.
• C. Avoid monitoring mood and cognition after starting.
• D. Choose antidepressants based solely on patient preference without clinical considerations.

Answer: (A)

Managing antidepressants in older adults focuses on safety and functioning as much as on mood improvement. Hyponatremia risk is a real concern in this population, especially with certain antidepressants and when diuretics are part of the regimen, so electrolyte monitoring and careful selection matter. Polypharmacy increases the chance of drug–drug interactions and cumulative adverse effects, so choosing agents with fewer interactions helps keep overall burden down. Falls risk is another key issue: some antidepressants can cause dizziness or sedation and contribute to falls, which are particularly dangerous in older adults. Cognitive effects are important as well, since anticholinergic properties or delirium-like symptoms can impair thinking and daily functioning; avoiding or minimizing agents with higher cognitive burden is often prudent. Tolerability drives adherence; if a medication causes bothersome side effects, an older patient is less likely to stick with it. All of this means the best approach is to choose antidepressants with favorable safety and tolerability profiles, monitor mood and cognition after starting, and adjust as needed to maintain both mood improvement and overall functioning.