How do you select an SSRI and dosing strategy for older adults newly being treated for depression?

SSRIs are preferred based on tolerability, drug interaction potential, and comorbidities. Start at low doses (e.g., sertraline 25 mg daily) and titrate gradually to therapeutic levels over 1–2 weeks, monitoring closely for adverse effects.

Among SSRIs, sertraline and escitalopram are particularly recommended as they rank highly for both efficacy and acceptability, with sertraline having the additional advantage of low drug interaction potential—critical in older adults.

Avoid paroxetine due to significant anticholinergic effects in older adults. Citalopram and escitalopram carry a possible QT prolongation risk and should be monitored for it.

Start SSRIs at one-third to one-half the usual adult dose to assess tolerability and minimize adver...