Antidepressants and other psychiatric medications can temper depression and anxiety, which, left untreated, can worsen isolation, cognitive decline, and chronic health problems.
“Antidepressants are among the most commonly prescribed psychotropic medications in older adults,” says Jason Jalil, MD, Director of the UCLA Longevity Center Memory & Lifestyle Program. “They can reduce the emotional and functional burden of depression and anxiety, improving quality of life and even overall health outcomes.”
But with age also comes a greater sensitivity to antidepressant side effects. Some of the same drugs that ease symptoms of depression and anxiety or help with sleep may raise the risk of falls, confusion, or heart rhythm changes, among other potential side effects. “A careful balance between therapeutic benefit and tolerability is essential,” Dr. Jalil emphasizes.
What Do Antidepressants Do?
Antidepressants work in a variety of ways to alter the way your brain uses certain chemicals (neurotransmitters), such as serotonin and norepinephrine, thereby helping to regulate your mood.
These medications, especially selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) and escitalopram (Lexapro), are usually a first-line treatment for mood and anxiety disorders in older adults. The most commonly prescribed class of antidepressants, SSRIs are generally safer than older types of antidepressants, such as tricyclics and monoamine oxidase (MAO) inhibitors, but they still require close monitoring for side effects. These effects can include nausea, dizziness, and low sodium levels, which can lead to confusion and falls.
Other commonly used types of antidepressants, known as serotonin-norepinephrine reuptake inhibitors (SNRIs), effectively treat depression and anxiety, and they’re also widely prescribed to manage certain chronic pain conditions, such as fibromyalgia and diabetic neuropathy. These drugs—examples include duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor)—can cause a range of side effects, such as nausea, dry mouth, dizziness, sleep disturbances, headache, blood pressure increases, and sexual dysfunction.
Benzodiazepines and sedative-hypnotics—such as lorazepam (Ativan), diazepam (Valium), and sleep aids like zolpidem (Ambien)—remain widely prescribed despite strong warnings against their long-term use in adults over 65.
“These should generally be avoided or used with great caution due to the heightened risk of falls, cognitive impairment, and dependence,” Dr. Jalil says. “These medications can relieve acute anxiety or insomnia, but the body’s slower metabolism in later life causes them to linger, amplifying side effects. Over time, dependence and memory issues may become harder to reverse or fully resolve.”
In Addition to Antidepressants
Dr. Jalil emphasizes that mental health care in older adults should never rely solely on pills. “There should always exist a drive to consider nonpharmacologic and behavioral interventions where possible,” he says. Physical activity, psychotherapy, mindfulness, and strong social connections have measurable, lasting effects on brain health and mood regulation. They can also lower medication doses or eliminate the need for some prescriptions entirely.
The National Institute of Mental Health notes that talk therapy, cognitive behavioral therapy, and lifestyle strategies (e.g., structured daily routines and improved sleep hygiene) can be as effective as medications for many people with depression and anxiety, without the potential side effects.
When Antidepressants Mimic Disease
A subtle but often overlooked danger in older adults is that antidepressant side effects can resemble the signs of age-related diseases. For instance, confusion, behavioral changes, or sudden disorientation are sometimes mistaken for dementia.
“Differentiating between medication side effects and the effects of aging or illness requires a careful assessment of timing, symptom onset, and recent medication changes,” Dr. Jalil explains. “Sudden confusion or agitation is a red flag that something reversible—possibly a drug interaction—is at play. Gradual cognitive decline suggests dementia; abrupt changes demand a medication review.”
Older bodies handle medications differently: Metabolism slows, kidney and liver function may decline, and the risk of accumulating drug effects rises. Consequently, even a previously well-tolerated medication might become risky over time.
The Problem of Polypharmacy
Polypharmacy—defined as taking five or more medications—is a growing issue among older Americans. According to the National Institute on Aging, nearly 40% of adults over 65 regularly take multiple prescription and over-the-counter drugs. Each new drug increases the potential for harmful interactions, not only between prescription medications but also with herbal supplements and vitamins.
Even seemingly harmless products can cause serious problems. For example, “St. John’s wort can interfere with antidepressants, leading to dangerous serotonin levels,” Dr. Jalil says. “Ginkgo biloba and ginseng may heighten bleeding risk when combined with anticoagulants. Goldenseal and kava can alter the metabolism of multiple prescription drugs.”
Fortunately, you can help reduce these risks. Dr. Jalil encourages maintaining a single, up-to-date list of every medication, supplement, and vitamin, “including over-the-counter products and anything previously prescribed that you still take occasionally.” Bringing that list to every medical appointment, including dental and eye visits, ensures that every prescriber understands the full picture.
Regular “brown bag” reviews, in which a clinician or pharmacist reviews all of your medications, can identify outdated prescriptions, unnecessary duplicates, and opportunities to lower doses or eliminate drugs that no longer serve a clear purpose.
Deprescribing: Less Can Be More
When medications begin to cause harm, stopping them safely becomes as important as starting them wisely. “Deprescribing” is the deliberate, clinician-guided process of tapering or discontinuing unnecessary drugs. This process requires patience and monitoring, but it can significantly improve cognition, balance, and overall quality of life.
Dr. Jalil notes that benzodiazepines often top the list of medications targeted for deprescribing. “The key is not abrupt withdrawal but gradual reduction under supervision, paired with supportive therapies that address lingering symptoms,” he says.
Participate in Your Care
Whether you’re taking antidepressants, other psychotropic medications, or any prescription or over-the-counter drugs, you and your caregivers play a critical role in medication safety. So, know the names and purposes of every drug you take, understand potential side effects, and ask questions at every visit with your health-care provider. Your pharmacist is a valuable ally in this process, as well, as he or she can cross-check new prescriptions for interactions with your existing regimen.
Consider medication labels, physician explanations, pill boxes/reminders, and smartphone apps as aids to track timing and dosages and prevent mistakes like double-dosing or missing pills. Above all, you should feel empowered to ask, “Do I still need this medication?”
The goal isn’t to deny helpful treatments but to use them wisely, with eyes open to both benefits and risks. In Dr. Jalil’s words, “Through proactive communication and regular medication monitoring, patients and clinicians can work together to minimize adverse effects and optimize treatment safety.”
