Tricyclic antidepressants older people

The brain is the focus of this book but it is not the only organ injured by SSRI antidepressants. A recent study of 2,722 older women (mean age 78.5) found that the SSRIs drastically reduced their bone densities (Diem et al., 2007). The bone mineral density (BMD) decreased by 0.82% per year in SSRI users, compared to 0.47% in nonusers (p <. 001). On the other hand, women using tricyclic antidepressants had the same BMD as nonusers. One wonders how this form of SSRI toxicity might be rationalized as therapeutic. Meanwhile, it is yet one more reason not to prescribe the drugs, especially to older people. 

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. 

Major depression is a common psychiatric illness associated with significant morbidity [25]. The illness is usually episodic and manifests with a depressed mood reduced energy changes in appetite, sleep, and concentration and psychological symptoms, such as reduced self-esteem and suicidal ideation. As many as 10% of people may experience a depressive episode at some point in their lives, with women more commonly affected than men. Despite its frequency, more than half of the patients with this illness remain untreated [26]. Unfortunately, the longer the duration of the illness, the poorer the outcome, with an increased rate of recurrence [27]. Effective treatment for depression has been available for nearly two generations. Older medications, the tricyclic antidepressants and... 

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