Newer antidepressants may increase the risk of serious health problems in older people compared to older pills, researchers say.
Selective serotonin reuptake inhibitors (SSRIs) are more likely to cause death and issues such as heart attack, stroke, falls and seizures than older tricyclic antidepressants (TCAs), according to a study published in the British Medical Journal (BMJ).
Researchers from the universities of Nottingham and East Anglia analysed data for more than 60,000 people diagnosed with depression between 1996 and 2007. All were aged 65 and over.
Those patients not taking any antidepressants had a 7% risk of dying from any cause but this rose to 8.1% for those taking TCAs and 10.6% for SSRIs.
The risk was even higher for other types of antidepressants, at 11.4%.
The risks of stroke and fracture were noticeably higher in those taking SSRIs compared to TCAs and SSRIs were linked to the most falls of any drugs.
The risk to the patient was highest in the first 28 days after starting an antidepressant, and in the first 28 days after stopping taking the drugs.
The findings held true even when other factors were taken into account, including age, sex, severity of depression, other illnesses and use of other medications.
One theory put forward by the researchers is that TCAs tended to be prescribed at lower doses than SSRIs and other antidepressants, which may partly explain the findings.
They warn that the risks and benefits of different antidepressants should be carefully evaluated when they are prescribed to older people.
In an accompanying editorial, Professor Ian Hickie from the University of Sydney said: "Given the potential harms, the decision to prescribe for an older person with depression should not be taken lightly."
Michelle Mitchell, charity director of Age UK, said: "Depression is the most common mental health problem in later life, affecting around a quarter of people aged 65 and over, yet it is often overlooked and wrongly seen as part of growing old.
"Older people are often reluctant to discuss their feelings and GPs often overlook signs and symptoms of depression, meaning the condition often goes undiagnosed and untreated.
"Any older person that has been feeling down ... for some time should speak to their GP and discuss suitable treatment options."