Challenges of prescribing antidepressants for the elderly: a scoping review

Objectives With a shift in global demographic trends favouring the older population, depression, which is increasingly common to older adults, is fast becoming a significant public health phenomenon that can result in rising healthcare costs, co-morbidities and fatalities. In particular, challenges to prescribing antidepressants to older people given their altered pharmacodynamic and pharmacokinetic profiles is of major concern to healthcare providers. We aimed to review the challenges encountered by prescribers when diagnosing and selecting older patients suited to receive an antidepressant. Methods English articles published between 2011 and 2021 were searched from the three databases which were MEDLINE, Cochrane Library and EMBASE to identify studies related to challenges in prescribing antidepressants for older people with the combination of search keywords such as depression, antidepressants, elderly and challenges, but not limited to them. Studies were excluded if the age of the participant is below 65 years old.The relevancy of the studies to be included were examined initially based on their titles and abstracts. Additional articles were searched from the reference lists of relevant articles. Key findings Out of 2500 studies, 11 articles was included in this study. The challenges were classified into three themes: challenges associated with the ageing processes, difficulty in recognising depressive symptoms and challenges in distinguishing depression from cognitive impairment. Conclusions Antidepressant prescribing in the elderly is complicated, in which there is a lack of proof for beneficial approaches. The study highlighted pertinent challenges to prescribers when older patients seek drug therapy for depression. This could have easily led to many depression cases gone undiagnosed or misdiagnosed.