The elderly frequently receive antidepressant medications that can affect cardiac conduction and rhythm, heart rate, and blood pressure. Because coexistent cardiovascular disease is common in the elderly, these medications must be used with caution, remembering that different antidepressants produce different cardiovascular effects. Fortunately, a variety of antidepressant medications are available, facilitating the selection of a safe agent for elderly patients who are at risk for cardiovascular side effects.