Depression in the elderly is an increasingly prevalent problem affecting some 15% of the elderly population and can be difficult to diagnose and treat. Complicating factors include poor compliance, the high frequency of concomitant disease, and the alterations in drug absorption and metabolism with age. This paper reviews controlled studies of the treatment of depression in elderly patients using paroxetine, a selective serotonin reuptake inhibitor. The studies demonstrate that paroxetine has efficacy in these patients which is similar to that of comparative compounds. The side effect profile of paroxetine is favourable, as compared with tricyclics, in terms of cardiovascular effects. The side effects of paroxetine in the elderly are similar to those reported in younger individuals. The improved tolerability profile of paroxetine is particularly welcome for the treatment of the elderly who have an increased sensitivity to adverse effects of drug therapy.