Optimizing antidepressant use in geriatric depression: expert consensus from French societies of geriatrics, old age psychiatry, and clinical pharmacy (SFGG, SF3PA, and SFPC)
Year: 2026
Type: article
Abstract: BACKGROUND: Late-life depression refers to a depression occurring in older adults, defined as individuals aged 65 years and older. It is common and often mismanaged due to complex clinical profiles, polypharmacy, and limited evidence-based guidance. Existing tools poorly address psychiatric nuances in older adults. This work aims to develop French recommendations based on experts' consensus on the use of antidepressants in unipolar late-life depression, to guide safer prescribing practices. METHODS: This tool was developed using a Delphi survey, based on a review of literature published between 2014 and 2024 and focused on "antidepressants" and "late-life depression" Experts from various fields: geriatric psychiatry, clinical pharmacy and general practice, rated items using a 9-point Likert scale. Items with a median score ≥ 7 and at least 80% agreement were validated and included in the final version of the tool. RESULTS: Twenty to 23 experts per round, different from the authors of the proposed items, participated in a four-round Delphi process. The resulting tool includes 57 validated items across 10 sections and a stepped-care algorithm for treating major depression in older adults. It addresses drug choice, dosing, monitoring, comorbidities, and treatment resistance, prioritizing safe first-line options like sertraline, citalopram, and escitalopram. CONCLUSION: A Delphi survey involving multidisciplinary experts led to a French consensus tool for prescribing antidepressants in unipolar late-life depression. It integrates clinical evidence and expert judgment to address treatment complexity, drug safety, and resistance. The tool offers practical, stepwise recommendations tailored to primary care, aiming to optimize antidepressant use, reduce iatrogenesis, and improve patient outcomes.
Source: European Psychiatry
Authors: Morgane Houix, Alexis Lepetit, Christophe Arbus, Sophie Armand-Branger, Sylvie Bonin-Guillaume, Benjamin Calvet, Mathieu Corvaisier, Ismael Conejero, Anne-Laure Debruyne, Sandrine Louchart de la Chapelle, Gérald Deschietere, Thomas Desmidt, Jean-Michel Dorey, Olivier Drunat, Jean-Pascal Fournier, Quentin Gallet, Jacques Gauillard, Cécile Hanon, Nicolas Hoertel, Ilia Humbert, Isabelle Jalenques, Aline Lepelletier, Frédéric Limosin, Nicolas Marie, Stéphanie Miot, Jean Olivier, Laurence Petit, Beatriz Pozuelo Moyano, Maximilien Redon, Gabriel Robert, Jean Roche, Tanguy Taillefer de Laportaliere, Pierre Vandel, Sonia Prot-Labarthe, Samuel Bulteau
Institutions: Inserm, Centre Hospitalier Universitaire de Nantes, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes Université, Hospices Civils de Lyon, Centre Hospitalier Universitaire de Toulouse, Assistance Publique Hôpitaux de Marseille, Centre Hospitalier Esquirol de Limoges, Centre Hospitalier Universitaire d'Angers, Centre Hospitalier Universitaire de Nîmes, Centre Hospitalier Charles Perrens, Princess Grace Hospital Centre, Cliniques Universitaires Saint-Luc, Centre Hospitalier Universitaire de Tours, Centre Hospitalier Le Vinatier, Hôpital Bretonneau, Hôpital Corentin-Celton, Hôpitaux Universitaires de Strasbourg, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre Hospitalier Guillaume Régnier, Centre Hospitalier Universitaire de Montpellier, Centre Hospitalier Universitaire Vaudois, Centre Hospitalier Universitaire de Lille
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,300
Funders: Bristol-Myers Squibb, Eisai, H. Lundbeck A/S
OpenAlex ID: W7140815000