Depressive and anxiety disorders are the most prevalent treatable mental disorders in older adults. Recovery from these disorders can occur in almost all patients and makes a dramatic difference in their level of functioning and quality of life. The proportion of older Americans being treated with an antidepressant (19%) has more than sextupled over the past two decades. However, most older patients do not appear to benefit from their antidepressant treatment. This lecture will review the evidence supporting the efficacy and the risks of antidepressant and other psychotropic medications in older adults. It will address some of the major issues that impede pharmacotherapy in older adults. Based on the substantial knowledge accumulated during the last three decades, this lecture will present a practical approach to overcome these clinical problems and maximize the effectiveness of pharmacotherapy when treating older patient with depressive and anxiety disorders.