Standard dosage	Varies by agent [35]. To minimize side effects, starting dose should be half of that prescribed for a younger adult. Increase dose over 1 to 2 week intervals, with plan to reach therapeutic dosing within 4 weeks. While average therapeutic dose is typically lower than that of a younger adult, there is a fair amount of inter-individual variability, and some older adults will require doses that meet or exceed the average therapeutic dose for younger adults [34].
Contraindications	Relatively few, apart from recent or current treatment with agents that increase risk for serotonin syndrome. Monitor sodium level in patients with history of hyponatremia.
Main drug interactions	Must avoid simultaneous treatment with MAO inhibitors. Escitalopram, citalopram, and sertraline are considered “cleaner” SSRIs, with fewer drug-drug interactions. “Dirtier” SSRIs include fluoxetine, paroxetine, and fluvoxamine, due to greater potential for drug-drug interactions [34].
Main side effects	Nausea, diarrhea, insomnia, sexual dysfunction, agitation, restlessness, and daytime sedation, among others.
Special points	Special caution must be used with citalopram, given risk for QT prolongation among adults older than sixty. In this population, the maximum FDA-approved dose for citalopram is 20 mg/day. For all SSRIs in elderly, check sodium level one month after starting treatment, given risk for Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in the elderly.
Cost-effectiveness	Citalopram and sertraline are more cost-effective than escitalopram, due to availability of generic formulations.