Tricyclic antidepressants elderly people

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... 

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... 

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