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Table 3 Therapeutic strategies in geriatric depression

From: Clinical guidelines for the management of depression with specific comorbid psychiatric conditions French recommendations from experts (the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental)

Clinical features First intention Second intention Contra-indications
Mild to moderate intensity - SSRI
- α2 antagonist
- SNRI
- Agomelatine
- Irreversible MAOI
- Bupropion
- Association with an ATD from the same pharmacological class
- Anticonvulsant
- ECT
Moderate to severe intensity - SSRI
- SNRI
- α2 antagonist
- Imipraminic - Bupropion
- Association with an ATD from the same pharmacological class
- Anticonvulsant
- First generation antipsychotic
Severe cognitive impairments - SSRI
- SNRI
- α2-antagonist
- Agomelatine
Severe psychomotor agitation - SSRI
- α2 antagonist
- SNRI
- Potentiation with AAP
- Bupropion
- Tianeptine
- Irreversible MAOI
- Association with an ATD from the same pharmacological class
Severe psychomotor retardation - SSRI
- SNRI
- α2-antagonist
- Imipraminic
- ECT in association
- Tianeptine
- Bupropion
- Association with an ATD from the same pharmacological class
- First generation antipsychotic
Severe sleep disorders - SSRI
- α2 antagonist
- SNRI
- Agomelatine
- Tianeptine
- Irreversible MAOI
- Bupropion
- Association with an ATD from the same pharmacological class
Severe anhedonia - SSRI
- SNRI
- α2-antagonist
- Imipraminic
- Agomelatine
- Association with an ATD from the same pharmacological class
- Anticonvulsant
- First generation antipsychotic
Psychotic symptoms - SNRI
- Potentiation with AAP
- SSRI
- α2-antagonist
- Imipraminic
- ECT in association
- Tianeptine
- Irreversible MAOI
- Bupropion
- Association with an ATD from the same pharmacological class
High suicidal risk - SSRI
- SNRI
- α2-antagonist
- Imipraminic
- ECT in association Potentiation with AAP
- Tianeptine
- Bupropion
- Association with an ATD from the same pharmacological class
- First generation antipsychotic
  1. AAP Atypical antipsychotic, ATD Antidepressant, ECT Electroconvulsive therapy, MAOI monoamine oxidase inhibitor, SSRI Selective serotonin reuptake inhibitors, SNRI Dual serotonin and norepinephrine reuptake inhibitors