Objective To systematically evaluate the efficacy and safety of escitalopram compared with paroxetine in the treatment of elderly patients with depression， so as to provide evidence-based reference for drug selection in the treatment of elderly patients with depression. Methods By retrieving from China National Knowledge Infrastructure（ CNKI）， Wanfang database， China Biology Medicine（ CBM） database， VIP database， PubMed and The Cochrane Library， randomized controlled trials（ RCTs） of escitalopram（ experimental group） campared with paroxetine（ control group） in the treatment of elderly patients with depression were collected. After the data extraction and quality evaluation of the studies meeting the inclusion criteria， the Rev Man 5.3 statistical software was used for meta-analysis. Rusults A total of 10 RCTs involving 823 patients were included. Meta-analysis results showed that， in the experimental group， the recovery rate（ OR=1.83， 95%CI： 1.26-2.65）， HAMD score（ OR=-2.80， 95%CI：-3.50--2.11）， GDS score（ OR=-2.03， 95%CI：-3.12--0.93）， total adverse reaction rate（ OR=0.45， 95%CI：0.36-0.58）， the incidence of xerostomia（ OR=0.32， 95%CI： 0.15-0.69）， The incidence of dizziness（ OR=0.38，95%CI：0.17-0.86）， the incidence of anorexia（ OR=0.35， 95%CI：0.16-0.79）， the incidence of nausea（ OR=0.40，95%CI：0.24-0.69）， the incidence of headache （OR=0.36， 95%CI： 0.14-0.95）， the incidence of fatigue（ OR=0.39， 95%CI： 0.19-0.80）， The incidence of constipation（ OR=0.34， 95%CI：0.17-0.69） were significantly lower than the control group， and the differences were statistically significan（t all P＜0.05）. In the experimental group， the significant effective rate（ OR=0.91， 95%CI： 0.63-1.31，P=0.62）， the incidence of drowsiness（ OR=0.57， 95%CI： 0.22-1.50，P=0.26） and the incidence of tachycardia（ OR=0.38， 95%CI： 0.14-1.02，P=0.05） had no statistically significant differences compared with those in the control group. Conclusions Existing evidence shows that escitalopram has certain advantages in efficacy and safety compared with paroxetine in the treatment of elderly patients with depression.