Dose of Tricyclic Antidepressants in Elderly Patients

Tan, Robert S.

doi:10.1001/jama.281.20.1891

Cited by 3 publications

(3 citation statements)

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“…TCA are effective in elderly patients, but given their adverse effects and the likelihood of cardiotoxicity in cases of overdose, they must be used only in patients who have previously had a good response to them. TCA are contraindicated in patients with a recent history of myocardial infarction, defects of cardiac conduction, glaucoma, orthostatic hypotension, urinary retention, hypertrophy of the prostate, or cognitive impairment …”

Section: Risk Of Antidepressant Drugs In the Elderlymentioning

confidence: 99%

“…TCA are contraindicated in patients with a recent history of myocardial infarction, defects of cardiac conduction, glaucoma, orthostatic hypotension, urinary retention, hypertrophy of the prostate, or cognitive impairment. 2,17,18 Monoamine oxidase inhibitors have a narrow therapeutic margin and require restrictions with several drugs and nutrients that content tyramine. This group of antidepressants is not recommended in the elderly, even when prescribed by professionals with experience with this type of antidepressants.…”

Section: Risk Of Antidepressant Drugs In the Elderlymentioning

confidence: 99%

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Risk–benefit analysis of antidepressant drug treatment in the elderly

et al. 2014

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Depression in the elderly is a significant health issue that has the potential to seriously affect physical and emotional well-being. Therefore, the treatment of geriatric depression is necessary. Antidepressant treatment in older depressed patients is efficacious, but differences in the effectiveness of different classes of antidepressants have not been demonstrated. However, differences in tolerability profile are most recognizable in the elderly. With ageing, a series of changes occur in the elderly that modify both the pharmacokinetics and pharmacodynamics of antidepressants and may influence the efficacy, tolerability and safety of treatment in the elderly. Comorbidities require the use of other drugs, which increases the possibility of drug-drug interactions. Given these aspects, individualized therapy for each elderly patient is needed to achieve acceptable risk-benefit ratio. Effective treatment of depression in the elderly, which may require combined pharmacological with psychosocial treatment, can decrease both morbidity and mortality; it also may lead to reduced demands on family members and on health-care and social services.

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Section: Risk Of Antidepressant Drugs In the Elderlymentioning

confidence: 99%

Section: Risk Of Antidepressant Drugs In the Elderlymentioning

confidence: 99%

Risk–benefit analysis of antidepressant drug treatment in the elderly

et al. 2014

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“…Tricyclic antidepressant therapy has been limited in recent years due to the emergence of selective serotonin reuptake inhibitors (SSRIs), but despite this they are not completely obsolete and are often still prescribed by physicians. Many physicians prefer to prescribe SSRIs to their patients, as they seem to be more effective and generally cause fewer side effects than tricyclic antidepressants (Gallo 1999;Tan 1999). Despite the popular use of SSRIs, tricyclic antidepressants are still used as an effective medication in certain cases, as SSRIs are often associated with increased anxiety.…”

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confidence: 99%

Shifts in metabolic parameters surrounding glucose homoeostasis resulting from tricyclic antidepressant therapy: implications of insulin resistance?

Chadwick

Wilson

Venter

et al. 2007

Journal of Pharmacy and Pharmacology

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This study displayed the physiological effects the tricyclic antidepressants amitriptyline or trimipramine have on glucose homoeostasis in male Wistar rats. An insulin secreting cell line (INS-1) was also used to determine effects tricyclic antidepressants have on insulin secretion and insulin displacement. Thirty rats each received a 1 mg kg-1 dose of amitriptyline or trimipramine for a period of 14 weeks; another 14 rats served as the control group. Blood glucose, serum insulin and muscle and liver glycogen levels were determined. Kidney, liver and muscle insulin degradation was measured and compared with insulin degrading enzyme concentrations in the latter two tissues. INS-1 cells were used to determine the effect 1 microM amitriptyline has on insulin secretion. Displacement studies for [3H]glibenclamide by amitriptyline or trimipramine were undertaken on INS-1 cells. A significant increase in blood glucose (P<0.01) was found for both test groups after 6 and 14 weeks of receiving the medication, which may be related to a significant decrease in liver and muscle glycogen levels (P<0.001). Serum insulin levels remained unchanged, although a significant increase in insulin degradation was observed in the muscle, liver and kidney, which may be related to a significant increase in insulin degrading enzyme (P<0.001) that was found. A significant increase in insulin secretion was observed for the INS-1 cells treated with amitriptyline, although no significant displacement for the [3H]glibenclamide was evident for amitriptyline or trimipramine. The significant alterations in glucose homoeostasis observed, as well as the significant changes associated with insulin secretion and degradation associated with amitriptyline or trimipramine treatment, imply that prolonged use of these medicines may lead to insulin resistance and full blown diabetes.

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