Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

Which class of antidepressants is considered first-line therapy for managing depression in elderly patients?

1. Selective serotonin reuptake inhibitors

2. Tricyclic antidepressants

3. Serotonin-norepinephrine reuptake inhibitors

4. Dopamine-norepinephrine reuptake inhibitors

The correct answer is: Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are considered first-line therapy for managing depression in elderly patients due to their favorable side effect profile and safety. SSRIs, such as sertraline, escitalopram, and fluoxetine, are preferred because they primarily affect serotonin levels in the brain, which can improve mood with fewer adverse effects compared to other classes of antidepressants. In elderly patients, there is a significant concern regarding the potential for side effects and drug interactions due to polypharmacy and the normal aging process, which can alter drug metabolism and elimination. SSRIs are associated with a lower risk of anticholinergic side effects, sedation, and cardiovascular complications, making them safer options for older adults. Additionally, SSRIs have a more tolerable profile in terms of weight gain and allow for once-daily dosing, which can enhance medication adherence. While other classes of antidepressants have their place in treatment, SSRIs remain the go-to choice for treating depression in this age group because they balance efficacy with safety, addressing both the need for effective symptom relief and the management of the specific health concerns prevalent among elderly patients.