When initiating antidepressants in older adults, what is recommended?

• A. Do not monitor adverse effects.
• B. Start low, go slow; monitor mood and cognition.
• C. Start with the highest dose.
• D. Avoid SSRIs entirely.

Answer: (B)

Starting antidepressants in older adults requires a cautious, monitored approach because aging alters drug handling and heightens sensitivity to side effects. The recommended method is to start with a low dose and go slowly, while closely monitoring mood and cognition. This helps ensure the medication is tolerated, allows you to track improvement in depressive symptoms, and quickly catch any cognitive changes or adverse effects that could affect safety or adherence. Jumping in with a high dose raises the risk of dizziness, falls, hyponatremia, delirium, and other problems, making treatment less tolerable and more prone to discontinuation. While selective serotonin reuptake inhibitors are commonly used in older adults, the key principle here is gradual titration with ongoing monitoring to balance efficacy and safety.