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Polypharmacy, the use of more medications than is clinically necessary, is a significant problem among frail, older adults.  With this in mind, we appraised the evidence for the efficacy and safety of antidepressants in frail, older adults, as they appear to be commonly prescribed to older adults who are frail. For example, in long-term care, where many frail, older adults reside, antidepressants are the second most commonly prescribed medication, with 60% of residents using an antidepressant and 36% using a selective serotonin reuptake inhibitor (SSRI). Although antidepressants may be prescribed for several conditions, we reviewed evidence on the efficacy of antidepressants for depression and the neuropsychiatric symptoms (NPS) of dementia, as these are frequent conditions in frailty. NPS refers to behavioural and affective symptoms commonly experienced in dementia (e.g., depression, wandering, resistance, agitation, aggression, sexually inappropriate behaviour, and change in sleep patterns). The use of antidepressants for NPS of dementia is an off-label indication, however, there has been increasing interest in the efficacy and safety of antidepressants for NPS due to concerns about the risks of stroke and death from antipsychotics. The evidence for non-drug (psychosocial) interventions was not assessed in this review.


Laurie Mallery, MD, FRCPC, MSM Dalhousie University

Constance LeBlanc, DSS, MD, CCFP, FCFP, MAEd Dalhousie University

Michael Allen, MD, MSc Dalhousie University

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