Optimizing Antidepressant Use in Geriatric Depression: Expert Consensus from French societies of geriatrics, old age psychiatry and clinical pharmacy (SFGG, SF3PA and SFPC)

Abstract

International audienceBackgroundLate-life depression refers to a depression occurring in older adults, typically defined as individuals aged 65 years and older. It is common and often mismanaged due to complex clinical profiles, polypharmacy and limited evidence-based guidance. Existing tools poorly address psychiatric nuances in older adults. This work aims to develop French recommendations based on experts consensus on the use of antidepressant in unipolar late-life depression, to guide safer prescribing practicesespecially in primary care-and address a major public health issue.MethodsThis tool was developed using a Delphi survey, based on a review of literature published between 2014 and 2024 and focused on "antidepressants" and "late-life depression" available on PubMed. Experts from various fields: geriatric psychiatry, clinical pharmacy and general practice, rated items using a 9point Likert scale. Items with a median score ≥ 7 and at least 80% agreement were validated and included in the final version of the tool.ResultsTwenty to twenty-three experienced experts per round, different from the authors of the proposed items, participated in a four-round Delphi process. The resulting tool, based on evidence and clinical expertise, includes 57 validated items across 10 sections and a stepped-care algorithm for treating major depression in older adults. It addresses drug choice, dosing, monitoring, comorbidities, and treatment resistance, prioritizing safe first-line options like sertraline, citalopram, and escitalopram.ConclusionA Delphi survey involving multidisciplinary experts led to a French consensus tool for prescribing antidepressants in unipolar late-life depression. It integrates clinical evidence and expert judgment to address treatment complexity, drug safety and resistance. The tool offers practical, stepwise recommendations tailored to primary care, aiming to optimize antidepressant use, reduce iatrogenesis, and improve patient outcomes