Antidepressants elderly people

Van Eijk, MEC., Avom, J., Porsius, A.J., de Boer, A. Reducing prescribing of highly anticholinergic antidepressants for elderly people randomised trial of group versus individual academic detailing. Br. Med. J. 322, 1-6, 2001. 

Because suicide is one of the leading causes of death in elderly people and in other populations, rapid and effective treatment of depression is warranted. Current therapies include the use of electroconvulsive (shock) therapy, psychiatric intervention, and antidepressant drugs such as tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and serotonin-selective reuptake inhibitors (SSRIs). Recently, in the U.S., the use of St. John s wort (Hypericum perforatum) has become more prevalent, especially in the treatment of depression. 

There have been other reports of hyponatremia with SSRIs (38,39). Hyponatremia is probably more common with SSRIs than with tricyclic antidepressants and predominantly but not exclusively affects older patients. Most reports involve fluoxetine, but this might represent greater patient exposure. All SSRIs and venlafaxine can produce this adverse effect (SEDA-23,21 SEDA-25,14). According to published reports, the median time to the onset of hyponatremia is 13 days (range 3-120) and the presentation is of inappropriate secretion of antidiuretic hormone (38). Symptoms, such as lethargy and confusion, can be non-specific, so awareness of the possibility of SSRI-induced hyponatremia, particularly in elderly people, is needed. 

Because of the concern expressed about the use of tricyclic antidepressants in elderly people, MAO inhibitors have been studied in this population (39). Patients with dementia benefited in mood (but not cognition), and some non-demented patients also improved. Adverse effects were considered less frequent or troublesome than those due to tricyclic compounds, although one patient taking tranylcypromine became paranoid and... 

ANTIMUSCARINICS ANTIDEPRESSANTS-MAOIs t occurrence of antimuscarinic effects such as blurred vision, confusion (in elderly people), restlessness and constipation Additive antimuscarinic effects Warn patients and carers, particularly those managing elderly patients... 

BUPROPION 1. ANTIBIOTICS - fluoroquinolones 2. ANTICANCER AND IMMUNO-MODULATING DRUGS-corticosteroids, interferons 3. ANTIDEPRESSANTS-TCAs 4. ANTIMALARIALS - chloroquine, mefloquine 5. ANTIPSYCHOTICS 6. BRONCHODILATORS -theophylline 7. CNS STIMULANTS 8. PARASYMPATHOMIMETICS T risk of seizures. This risk is marked in elderly people, in patients with a history of seizures, with addiction to opiates/cocaine/ stimulants, and in diabetics treated with oral hypoglycaemics or insulin Bupropion is associated with a dose-related risk of seizures. These drugs, which lower seizure threshold, are individually epileptogenic. Additive effects occur when combined Extreme caution. The dose of bupropion should not exceed 4S0 mg/day (or 150 mg/day in patients with severe hepatic cirrhosis)... 

MDMA ANTIDEPRESSANTS Risk of hyponatraemia, particularly where dehydration may occur, such as long periods of dancing. The CSM has advised that hyponatraemia should be considered in all patients who develop drowsiness, confusion or convulsions while taking an antidepressant Hyponatraemia (usually in elderly people and possibly due to inappropriate secretion of ADH) has been associated with all types of antidepressant, more frequently with SSRIs. Additive effect Be aware and measure serum electrolytes when there is clinical suspicion... 

Elderly people have high rates of depression but tend to be excluded from randomized trials of antidepressant... 

Supportive care Supportive care, especially for elderly and people with renal disease Supportive care rv Mannitol Supportive care Tricyclic antidepressants Children more vulnerable than adults... 

---