What antidepressant is safe in an 85 year old patient with a history of paroxysmal afib, currently taking 0.5mg ativan (lorazepam) qhs?

Stop ativan (lorazepam): Depends on the other symptoms. If sleeping issues, loss of appetite, Mirtazapine is a good start. I would stop the Ativan (lorazepam) altogether. If person has anxiety, i would assess an underlying cognitive impairment and probably has dementia.

SSRI's, possibly: It depends on other illnesses/symptoms the patient may have, but possibly Celexa or zoloft could be helpful. Neither has reports of atrial fibrillation with them. Out of the ssri's Lexapro had one case, but still that makes this side effect very rare with ssri's. Paxil (paroxetine) could be considered, but not my first choice because of drowsiness, etc that can commonly happen. Why on Ativan at all?

AD: Wellbutrin (bupropion) is cardiac safe. Use may help energy, motivation, pleasure, cognitive symptoms. Like mentioned by other doctors some ssris can help.

Antidepressant: An antidepressant that has no effect on the heart or cardiovascular system would be an option to discuss with your doctor. Some ssris at low dose such as lexapro, or wellbutrin (bupropion) are options.

Geriatric depression: Trazode and Mirtazapine are my choice / if there is behavioral issues as well then i choose seroquel (quetiapine) but needs to make sure there is no contrindication.

Be careful: Eliminating unnecessary medications or at least lowering the doses that will allow. Wellbutrin (bupropion) can exacerbate cardiac arrhythmia so is not a panacea. My father developed congestive heart failure on it - almost immediately after starting it.

QTc prolongation: Any QTc prolongation in the patient? many psychotropic medications may cause QTc prolongation and I would be hesitant to use particular antidepressants. I would consider lower doses of prozac, zoloft, or consider very small doses or celexa or lexapro (escitalopram) (concern for qtc in higher doses and needing lower dosing given age). I would personally avoid seroquel in an 85 yo if at all possible.