Use of antidepressants in medically ill older patients.

Major depression is common in older medical patients, and it can exert a deleterious effect on the treatment, course, and outcome of physical illnesses. Tricyclic or tetracyclic antidepressants (TCAs) and psychosocial interventions often play a role in the treatment of depressed medically ill patients, but well-founded doubts about the efficacy and the safety of TCAs in older, frail medical patients have developed. Based on a review of current knowledge about antidepressant use in these patients, the authors recommend the cautious use of TCAs in medically ill older patients until more data are available.