OBJECTIVES:  This study examined the prevalence and predictors of antidepressant medication use among elderly patients with depression in ambulatory settings. METHODS:  This retrospective cross-sectional study utilized 2011 National Ambulatory Medical Care Survey (NAMCS) data. The study included patients aged 65 years or older diagnosed with depression. Antidepressant medications were operationally defined using the American Hospital Formulary Service Pharmacologic-Therapeutic classification and identified using Multum lexicon codes. Antidepressant medication classes included were Tricyclic antidepressants (TCAs), Selective Serotonin Reuptake Inhibitors (SSRIs), Monoamine oxidase inhibitors (MAOIs), Tetracyclic antidepressants, Selective Serotonin Norepinephrine Reuptake Inhibitors (SSNRIs), Phenylpiperazines and miscellaneous antidepressants.Descriptive weighted analysis was used to examine prevalence of antidepressant medications prescription. Independent variables included patient characteristics such as sex, age, race, ethnicity, region, and payment sources; and provider characteristics like physician medical degree, specialty type, office setting type, metropolitan statistical area, solo practice, primary physician and whether the patient was seen before. Multivariable logistic regression was used to assess the predictors of antidepressant therapy. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using an a priori alpha level of 0.05. RESULTS:  In 2011, a national estimate of 26.51 (95% CI, 21.70-31.32) million office visits were made by elderly patients with depression in the United States. Of these 11.82 (95% CI, 9.22-14.43, 44.59%) million involved prescribing of antidepressants. The most commonly prescribed antidepressants were SSRIs (31.16%), followed by SSNRIs (8.07%) and Phenylpiperazines (4.03%). Multivariable analysis revealed that compared to other payment sources, patients with Medicare (OR, 0.348; 95% CI, 0.17-0.71) and private insurance (OR, 0.37, 95% CI, 0.21-0.67) were less likely to receive antidepressant medication therapy. CONCLUSIONS:  The study found that 45% of the elderly depression visits involved prescription of antidepressant medications. SSRIs were the most commonly prescribed antidepressants. Payment source was a significant predictor of antidepressant drug prescription.