There is a high risk of side effects when prescribing antidepressants in the elderly. These can be avoided or minimised by tailoring the choice of antidepressant to the individual, by being aware of potential drug interactions and by bearing in mind the impact of co-morbidities. Drs Ayodeji Soyinka and David Lawley explore the evidence base and main side effects of antidepressants in common use in the elderly and how these might influence prescribing.