SSRIs considered to have the best safety profile in the elderly are citalopram, escitalopram, and sertraline.
Buspirone is an anti-anxiety drug that has been shown to be effective for older adults. Benzodiazepines, another anti-anxiety drug, are effective but should be prescribed carefully to older adults because of risk of memory impairment, unsteadiness, and falls.
Overall, citalopram appears to be the best-tolerated SSRI, followed by fluoxetine, sertraline, paroxetine, and fluvoxamine. The latter 2 drugs are associated with the most side effects and the highest discontinuation rates because of side effects in clinical trials.
Sertraline is generally well tolerated in elderly patients with major depressive disorder and lacks the marked anticholinergic effects that characterise the adverse event profiles of tricyclic antidepressants (TCAs).
Second, antidepressants are effective in treating depression in older populations, although they are not always as effective as we and our patients would like. Third, antidepressants have side effects and risks, some of which can be observed acutely while others may be longer-term consequences.
The antidepressants most widely prescribed for anxiety are SSRIs such as Prozac, Zoloft, Paxil, Lexapro, and Celexa. SSRIs have been used to treat generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and post-traumatic stress disorder.
However, elderly patients may be more sensitive to the effects of this medicine than younger adults, and are more likely to have hyponatremia (low sodium in the blood), which may require caution and an adjustment in the dose for patients receiving paroxetine.
SSRIs considered to have the best safety profile in the elderly are citalopram, escitalopram, and sertraline.  These have the lowest potential for drug-drug interactions based on their cytochrome P-450 interactions.
Citalopram and escitalopram have been considered the safest among the SSRIs with respect to potential for liver injury .
When the researchers checked which depression drugs were tolerated the best, these topped the list:
Mirtazapine is clearly better tolerated than tricyclic agents and is appropriate for some geriatric patients. Mirtazapine may be especially helpful in those who need a sedating agent or in patients who need to gain weight. An increase in appetite was reported in 17 percent of patients taking mirtazapine.
A 2014 study published in International Clinical Psychopharmacology suggested that Lexapro may be more effective and better tolerated than Zoloft or Paxil. Lexapro has different binding site interactions which may lead to better efficacy and tolerability.
Gurvich and Cunningham state in their article1 on psychotropic drugs in nursing homes that fluoxetine (Prozac) is not recommended in the geriatric population because of its longer half-life of active metabolite relative to other selective serotonin reuptake inhibitors (SSRIs), resulting in the potential for a longer
They said antidepressants like Lexapro, made by Forest Laboratories Inc and known generically as escitalopram, may be useful as a new treatment option for older adults with generalized anxiety disorder, a disabling condition that can also cause muscle tension, insomnia and fatigue.
In studies, Celexa was as effective and safe in people ages 65 and older as in younger people. However, older people who take Celexa may be at greater risk for a side effect known as hyponatremia, in which there is not enough salt in the fluid surrounding cells in the body.
Lithium remains the treatment of choice for bipolar mania in elderly patients. Although lithium has greater proven efficacy than other mood stabilizers with respect to treating and preventing manic episodes and reducing suicidal behavior17 there is a dearth of good studies of its use in the elderly population.