. Author manuscript; available in PMC: 2015 Aug 1.

Published in final edited form as: Clin Geriatr Med. 2014 Jun 14;30(3):517–534. doi: 10.1016/j.cger.2014.05.002

Table 4.

Updated Pharmacotherapy Algorithm for the Treatment of Late-Life Depression

	Majority consensus and minority alternative
Step 1	Escitalopram Alternatives: sertraline, duloxetine
Step 2 for minimal or non-response)	Switch to duloxetine Alternatives: venlafaxine, desvenlafaxine
Step 3 for minimal or non-response	Switch to nortriptyline Alternative: bupropion
Step 2-3 for partial response	Augment antidepressant with lithium or an atypical antipsychotic Alternatives: combine SSRI or SNRI with mirtazapine or bupropion
Duration of each step	6 weeks Alternatives: 4 weeks; 8 weeks

SSRI: selective-serotonin reuptake inhibitor; SNRI: serotonin-norepinephrine reuptake inhibitor