Antidepressant drug interactions in the elderly

Cadieux, Roger J.

doi:10.3810/pgm.1999.11.780

Cited by 34 publications

(4 citation statements)

References 12 publications

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“…In clinical practice, during a antidepressive SSRIs treatment, the above mentioned modifications of the aqueous humor and/or blood dynamics are difficult to diagnose as much as to predict, because the real plasma concentration of both parent drug and its metabolites has a significant inter-individual variability. In fact, peculiar genetic mosaicism of cytochrome P450 (CYP) enzymes and/or several acquired pathophysiologic conditions, affecting the detoxifying processes, are able to delay the SSRIs biotransformation and elimination, prolonging their serotonergic effects in an unforeseeable fashion (individual peculiar SSRIs tolerability) [7, 23, 55, 141, 142]. …”

Section: Effect Of Ssris On the Intraocular Pressure And Their Possibmentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitors: A Review of its Effects on Intraocular Pressure

Costagliola

Parmeggiani²,

Semeraro³

et al. 2008

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The increase in serotonin (5-HT) neurotransmission is considered to be one of the most efficacious medical approach to depression and its related disorders. The selective serotonin reuptake inhibitors (SSRIs) represent the most widely antidepressive drugs utilized in the medical treatment of depressed patients. Currently available SSRIs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram and escitalopram. The primary SSRIs pharmacological action’s mechanism consists in the presynaptic inhibition on the serotonin reuptake, with an increased availability of this amine into the synaptic cleft. Serotonin produces its effects as a consequence of interactions with appropriate receptors. Seven distinct families of 5-HT receptors have been identified (5-HT1 to 5-HT7), and subpopulations have been described for several of these. The interaction between serotonin and post-synaptic receptors mediates a wide range of functions. The SSRIs have a very favorable safety profile, although clinical signs of several unexpected pathologic events are often misdiagnosed, in particular, those regarding the eye. In all cases reported in the literature the angle-closure glaucoma represents the most important SSRIs-related ocular adverse event. Thus, it is not quite hazardous to hypothesize that also the other reported and unspecified visual disturbances could be attributed - at least in some cases - to IOP modifications. The knowledge of SSRIs individual tolerability, angle-closure predisposition and critical IOP could be important goals able to avoid further and more dangerous ocular side effects.

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Section: Effect Of Ssris On the Intraocular Pressure And Their Possibmentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitors: A Review of its Effects on Intraocular Pressure

Costagliola

Parmeggiani²,

Semeraro³

et al. 2008

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“…Little is known about more serious adverse effects of antidepressants, particularly in older people, in whom adverse drug events may be more common in the treatment of depression compared with younger groups because of higher levels of comorbidity, age related physiological changes, and polypharmacy 8. The under-representation of older people in clinical trials of antidepressants and the fact that most such trials are short term make deriving reliable or precise estimates of the incidence of adverse events in this group difficult 9…”

Section: Introductionmentioning

confidence: 99%

Antidepressant use and risk of adverse outcomes in older people: population based cohort study

Coupland

Dhiman

Morriss

et al. 2011

BMJ

692

620

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Selective serotonin reuptake inhibitors and drugs in the group of other antidepressants were associated with an increased risk of several adverse outcomes compared with tricyclic antidepressants. Among individual drugs, trazodone, mirtazapine, and venlafaxine were associated with the highest risks for some outcomes. As this is an observational study, it is susceptible to confounding by indication, channelling bias, and residual confounding, so differences in characteristics between patients prescribed different antidepressant drugs that could account for some of the associations between the drugs and the adverse outcomes may remain. Further research is needed to confirm these findings, but the risks and benefits of different antidepressants should be carefully evaluated when these drugs are prescribed to older people.

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“…Clinical trials tend to exclude older persons often due to physical frailty [ 6 ]. This is problematic as medication use patterns, treatment response and side effects may all differ between younger and older users of antidepressants, due to higher levels of psychiatric and somatic comorbidities in the older group, as well as age-related physiological changes [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Antidepressants and suicidal behaviour in late life: a prospective population-based study of use patterns in new users aged 75 and above

Hedna

Sundell

Hamidi

et al. 2017

Eur J Clin Pharmacol

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PurposeTo investigate associations between antidepressant use patterns and risk of fatal and non-fatal suicidal behaviours in older adults who initiated antidepressant therapy.MethodA national population-based cohort study conducted among Swedish residents aged ≥ 75 years who initiated antidepressant treatment. Patients who filled antidepressant prescriptions between January 1, 2007 and December 31, 2013 (N = 185,225) were followed until December 31, 2014. Sub-hazard ratios of suicides and suicide attempts associated with use patterns of antidepressants, adjusting for potential confounders such as serious depression were calculated using the Fine and Gray regression models.ResultsDuring follow-up, 295 suicides and 654 suicide attempts occurred. Adjusted sub-hazard ratios (aSHRs) were increased for both outcomes in those who switched to another antidepressant (aSHR for suicide 2.42, 95% confidence interval 1.65 to 3.55, and for attempt 1.76, 1.32 to 2.34). Elevated suicide risks were also observed in those who concomitantly filled anxiolytics (1.54, 1.20 to 1.96) and hypnotics (2.20, 1.69 to 2.85). Similar patterns were observed for the outcome suicide attempt. Decreased risk of attempt was observed among those with concomitant use of anti-dementia drugs (0.40, 0.27 to 0.59).ConclusionSwitching antidepressants, as well as concomitant use of anxiolytics or hypnotics, may constitute markers of increased risk of suicidal behaviours in those who initiate antidepressant treatment in very late life. Future research should consider indication biases and the clinical characteristics of patients initiating antidepressant therapy.Electronic supplementary materialThe online version of this article (10.1007/s00228-017-2360-x) contains supplementary material, which is available to authorized users.

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Antidepressant drug interactions in the elderly

Cited by 34 publications

References 12 publications

Selective Serotonin Reuptake Inhibitors: A Review of its Effects on Intraocular Pressure

Selective Serotonin Reuptake Inhibitors: A Review of its Effects on Intraocular Pressure

Antidepressant use and risk of adverse outcomes in older people: population based cohort study

Antidepressants and suicidal behaviour in late life: a prospective population-based study of use patterns in new users aged 75 and above

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