Depressed mood may be less prominent in older patients.

SSRIs are often considered first-choice antidepressants for older patients.

Bupropion, venlafaxine, and mirtazapine are also effective and well-tolerated.

Hyponatremia is more common in older patients.

Symptoms of depression in childhood include boredom, anxiety, failing adjustment, and sleep disturbance.

Data supporting the efficacy of antidepressants in children and adolescents are sparse.

Fluoxetine and escitalopram are FDA-approved for patients below 18 years of age.

All antidepressants carry a black box warning regarding increased risk for suicidal ideation and behavior in this population.

Several cases of sudden death have been reported in children and adolescents taking Desipramine, and baseline electrocardiogram (ECG) is recommended.

Individuals who discontinue antidepressant therapy during pregnancy are five times more likely to have a relapse during pregnancy than those who continue treatment.

The absolute risk of antidepressant use in pregnancy is unknown.

Risks reported with SSRIs use in pregnancy include low birth weight, respiratory distress, and congenital heart defects.

The risks and benefits of drug therapy during pregnancy must be weighed, including concerns about untreated depression.

There is uncertainty regarding long-term antidepressant exposure in infants through human milk due to a lack of data.

One in three patients who did not achieve remission with an antidepressant may become symptom-free when an additional medication (e.g., bupropion SR or buspirone) is added.

One in four may achieve remission after switching to a different antidepressant (e.g., venlafaxine XR, bupropion, or sertraline).

The current antidepressant may be augmented by adding another agent (e.g., lithium or triiodothyronine [T3]).

Second-generation antipsychotics (e.g., aripiprazole, quetiapine, brexpiprazole) can be used to augment antidepressant response.

New medications such as ketamine and esketamine may also be considered.

After 6–8 weeks of treatment:

Before changing treatment, evaluate the adequacy of the medication dosage and adherence, as most “treatment-resistant” depressed patients have received inadequate therapy.