Which antidepressant is commonly included in Beers Criteria as anticholinergic?

• A. Amitriptyline
• B. Sertraline
• C. Fluoxetine
• D. Citalopram

Answer: (A)

Anticholinergic burden is a major concern in older adults because it can worsen delirium, cognitive impairment, constipation, and falls. Beers Criteria highlights medications with strong anticholinergic effects as potentially inappropriate for seniors. Among common antidepressants, amitriptyline—a tricyclic antidepressant—produces potent muscarinic receptor blockade, giving it high anticholinergic activity. That makes it a frequent inclusion in Beers Criteria for being anticholinergic. The other listed antidepressants—sertraline, fluoxetine, and citalopram—have far less anticholinergic activity, so they’re not flagged for anticholinergic burden in the Beers Criteria (though other safety considerations may apply).