Are antidepressants effective in the treatment of depression in the elderly? A critical umbrella review on reviews, methods, and future perspectives

Abstract

The elderly are currently the most frequent users of antidepressants across ages, despite having a high risk of adverse effects (AEs). This literature review critically reviews the current evidence of the effectiveness of antidepressants and AEs in the elderly and discusses methodological limitations and future directions. Elements of Preferred Reporting Items for Systematic reviews and Meta-Analyses and Population, Intervention, Control, and Outcomes guidelines were applied. Search in Scopus, PubMed, PsycInfo/Ovid, Cochrane Library, and Google Scholar for relevant systematic- and meta-reviews on effectiveness and AEs studies. Ten reviews were identified and summarized within the last decade. Studies showed only modest superiorities to placebo in response rates if any, and only a few studies reached significant remission. Moreover, there was evidence of lower efficacy for patients over 65. AEs were common and problematic among the elderly in the studies reporting them. The evidence of the benefits of antidepressants in the elderly was weak and alternative treatments are advised. Despite the lack of clear evidence for the efficacy, UK National Institute for Health and Care Excellence guidelines have not incorporated separate recommendations for the elderly.