OBJECTIVES: Although atypical antipsychotics are indicated for management of late-life depression, little is known about their use in the elderly. The objective of this study was to determine the prevalence and predictors of atypical antipsychotics and augmentation therapy in elderly patients with depression. METHODS:  This study utilized the 2010 and 2011 National Ambulatory Medical Care Survey and outpatient department component of the National Hospital Ambulatory Medical Care Survey data. The study included elderly patients (age >=65years) diagnosed with depression. Atypical antipsychotics and antidepressants were identified using American Hospital Formulary Service classification and Multum lexicon codes. Descriptive weighted analysis was performed to determine the prevalence of atypical antipsychotic use and multivariable logistic regression analyses were performed to determine the factors associated with the prescription of atypical antipsychotics and augmentation therapy. RESULTS: According to the national surveys, there were about 22 million ambulatory visits for depression during the study period; atypical antipsychotics were prescribed in 3.53% (95% CI, 2.02-5.04) of the visits. Among depression patients who were using antidepressants, 4.86% (95% CI, 3.07-6.04) used as an augmentation therapy. Multivariable regression analysis revealed that hispanics (odds ratio [OR] = 0.33; 95% CI, 0.12-0.90) was associated with decreased likelihood of antipsychotic prescription, whereas personality disorder and obsessive compulsive disorder (OR = 10.23; 95% CI, 2.80-37.40) were associated with increased likelihood of prescribing antipsychotics. For augmentation therapy, hispanics (OR = 0.06; 95% CI, 0.02-0.24) and primary physicians (OR = 0.24; 95% CI, 0.09-0.69) were associated with decreased likelihood; and obsessive compulsive disorder and personality disorder (OR = 7.56; 95% CI, 1.75-32.69) were associated with increased likelihood of antipsychotic prescription. CONCLUSIONS:  Several clinical and demographic factors contribute to atypical antipsychotics use in the elderly. With the increased safety concerns, there is a need to monitor treatment related adverse effects in the elderly.