Discusses pharmacotherapy for depression in the elderly. The author discusses pretreatment consideration, commonly used antidepressant medications and usual doses, choice of specific pharmacological treatment, treatment-resistant depression, and strategies for treatment of failure to respond to pharmacotherapy in the acute phase. The author suggests that a large majority of elderly patients with depression could be treated successfully, particularly with the selective serotonin reuptake inhibitors, due to their favorable side-effect profile and low toxicity in overdose. The challenge with these drugs is drug-drug interactions.