Depression in elderly

The author cites the example of untreated depression in elderly people (lines 35-38) in order to... 

Methyldopa (Aldomet) and methyl dopa-hydrochloro thiazide (Aldoril) May cause bradycardia, and exacerbate depression in elderly patients. High... 

Depressive symptoms occur in about 15% of community residents older than age 65 years (287). The prevalence of major depression in elderly patients is estimated to be about 3%. Notably, a depressive episode is predicted to develop in 13% of patients admitted to a nursing home within 1 year. Elderly patients are even more predisposed to depression than younger age groups because of the following ... 

For these, as well as other reasons (e.g., altered life roles, chronic medical disorders), psychosocial therapies must always be included as part of a comprehensive treatment strategy for depression in elderly patients. 

Freedland KE, Carney RM, Rich MW. 1991. Depression in elderly patients with heart failure. J Geriatr Psychiatry... 

Livingston, G., Blizard, B. and Mann, A. Does sleep disturbance predict depression in elderly people A study in inner London. Br.. Gen. Pract. 43 (1993) 445-448. Robertson, D. R. Drug therapy for Parkinson s disease in the elderly. Br. Med. Bull. 46 (1998) 124-136. 

Barbiturates are a type of sedative-hypnotic used to induce sleep and as an anesthetic. In high doses barbiturates control epileptic seizures. Barbiturates are Class II controlled substances prescribed for no more than 2 weeks because of adverse side effect such as CNS depression in elderly persons. 

Prominent symptoms of depression in the elderly are loss of appetite, cognitive impairment, sleeplessness, anergia, fatigue, and loss of interest in and enjoyment of the normal pursuits of life. 

Schweizer E, Rickels K, Hassman H, Garcia-Espana F. (1998). Buspirone and imipramine for the treatment of major depression in the elderly. J din Psychiatry. 59(4) 175-83. 

These include trazodone and a derivative of its metabolite nefazodone, both of which are strongly sedative, an effect which has been attributed to their potent alpha-1 receptor antagonism rather than to any antihistaminic effects. A main advantage of these drugs in the treatment of depression is that they appear to improve the sleep profile of the depressed patient. Their antidepressant activity is associated with their weak 5-HT reuptake inhibition and also a weak alpha-2 antagonism. However, unlike most of the second-generation antidepressants, neither drug is effective in the treatment of severely depressed patients. Furthermore, there is some evidence that trazodone can cause arrythmias, and priapism, in elderly patients. 

Acute abdominal conditions Narcotics may obscure diagnosis or clinical course. Do not give SR morphine to patients with Gl obstruction, particularly paralytic ileus, as there is a risk of the product remaining in the stomach for an extended period and the subsequent release of a bolus of morphine when normal gut motility is restored. Special risk patients Exercise caution in elderly and debilitated patients and in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation. Also exercise caution in patients sensitive to CNS depressants, including those with cardiovascular disease myxedema convulsive disorders increased ocular pressure acute alcoholism delirium tremens cerebral arteriosclerosis ulcerative... 

Citalopram (Celexa) [Antidepressant/SSRI] WARNING Closely monitor for worsening depression or emergence of suicidality, particularly in pts <24 y Uses Depression Action SSRI Dose Initial 20 mg/d, may t to 40 mg/d X in elderly hqjatic/renal insuff Caution [C, +/-] Hx of mania, Szs pts at risk for suicide Contra MAOI or w/in 14 d of MAOI use Disp Tabs, cap, soln SE Somnolence, insomnia, anxiety, xerostomia, diaphoresis, sexual dysfxn Notes May cause X Na /SIADH Interactions t Effects W/ azole antifungals, cimetidine, Li, macrolides, EtOH t effects OF BBs, carbamazepine, CNS drugs, warfarin X effects W/ carbamaz ine X effects OF phenytoin may cause fatal Rxn W/ MAOIs EMS Use caution w/ CNS depressants, may need a reduced dose concurrent EtOH... 

Flurazepam (Dalmane) [C-IV] [Sedative/Hypnotic/ Benzodiazepine] Uses Insomnia Action Benzodiazepine Dose Adults Beds >15 y. 15-30 mg PO qhs PRN X in elderly Caution [X, /-] Elderly, low albumin, hepatic impair Contra NAG PRG Disp Caps SE Hangover d/t accumulation of metabolites, apnea, anaphylaxis, angioedema, amnesia Interactions T CNS depression W/ antidepressants, antihistamines, opioids, EtOH T effects OF digoxin, phenytoin T effects W/ cimetidine, disulfiram, fluoxetine, iso-niazid, ketoconazole, metoprolol, OCPs, propranolol, SSRIs, valproic acid. 

Closely monitor for worsening depression or emergence of suicidality, particularly in ped pts Uses OCD Action SSRI Dose Initial 50-mg single qhs dose, T to 300 mg/d in -s- doses X in elderly/hepatic impair, titrate slowly doses >100 mg Caution [C, /-] Interactions (MAOIs, phenothiazines, SSRIs, serotonin agonists. 

Quazepam (Doral) [C IV] [Sedative/Hypnotic/ Benzodiazepine] Uses Insomnia Action Benzodiazepine Dose 7.5-15 mg PO hs PRN i in elderly hqjatic failure Caution [X, /-] NA glaucoma Contra PRG, sleep apnea Disp Tabs SE Sedation, hangovCT, somnolence, resp depression Interactions T Effects W/ azole antifungals, cimetidine, digoxin, disulfiram, INH, levodopa, macrolides, neuroleptics, phenytoin, quinolones, SSRIs, verapamil, grapefruit juice, EtOH effects W/carbamazepine, rifampin, rifabutin, tobacco EMS Use caution w/ other benzodiazepines, antihistamines, opioids and verapamil, can T CNS depression concurrent EtOH and grapefruit juice use T CNS depression OD May cause profound CNS depression, confusion, bradycardia, hypotension, and altered reflexes flumazenil can be used as antidote activated charcoal may be effective... 

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