Antonio Del Casale, Paolo Girardi, Roberto Brugnoli, Gabriele Sani, Simone Di Pietro, Chiara Brugnoli, Federica Caccia, Gloria Angeletti, Daniele Serata, Chiara Rapinesi, Roberto Tatarelli, Giorgio D. Kotzalidis

Introduction. The elderly population is more frequently subjected to depressive mood compared to the general
population and show peculiarities affecting responsiveness; furthermore, aged people need also special care. Duloxetine is
a relatively new antidepressant that proved to be effective in adult depression, but has received little attention in elderly populations
heretofore. Aim. To review the evidence of duloxetine in late-life major depressive disorder (MDD). Method. A systematic
review of studies focusing on the use of duloxetine in MDD in the elderly has been carried out through the principal
specialized databases, including PubMed, PsycLIT, and Embase. Results. Only a handful of papers were specifically dedicated
to this issue. Duloxetine was found to be effective and safe in old-age MDD, to be better than placebo on many clinical
measures in all studies, and to better differentiate from placebo with respect to selective serotonin reuptake inhibitors. Compared
to placebo, its side-effect profile is slightly unfavorable and its drop-out rate is slightly higher. Furthermore, when pain
is present in old-age MDD, duloxetine is able to reduce it. Conclusions. The efficacy and safety of duloxetine in old-age depression
are similar to those encountered in adult MDD. There is a relative lack of comparative studies other than with placebo.
The special needs of elderly patients with MDD must be addressed with close patient contact to avoid the perils of inappropriate
dosing.