Drug-induced illness in the elderly

Harper, Cynthia M.; Newton, Patricia A.; Walsh, John R.

doi:10.1080/00325481.1989.11704370

Cited by 16 publications

(4 citation statements)

References 55 publications

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“…Whenever the possibility of depression as a side-eect is considered,`withdraw the potential oender and simultaneously consider antidepressant therapy' (Gelenberg, 1990). In the elderly, discontinuing a drug, whenever medically possible, is often more appropriate than adding another one (Harper et al, 1989;Blazer, 1989). Clinicians have to make these kinds of decisions, and we have oered some literature-based and clinical±epidemiological background for this task.…”

Section: Discussionmentioning

confidence: 99%

Depressogenic medication as an aetiological factor in major depression: an analysis in a clinical population of depressed elderly people

Dhondt¹,

Derksen²,

Hooijer³

et al. 1999

Int. J. Geriat. Psychiatry

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Objective To study the role of depressogenic medication in the aetiology of major depression in the elderly. Background Depression can be caused, provoked or sustained by drugs prescribed for other reasons. The evidence for this statement is based on case‐reports, not on investigations in relevant populations. Method In the geriatric wards of three Dutch psychiatric hospitals, 195 patients with a DSM‐III‐R diagnosis of major depression (MDD) were studied. In the first week after admission the following data were recorded: age, gender, personal psychiatric history, family psychiatric history, Montgomery‐Asberg Depression Rating Scale, Mini‐Mental State Examination, history of stroke, use of medication and number of different medications used. Subjects using depressogenic medication were contrasted with subjects not using depressogenic medication on all variables. Results There was a significant negative relationship, adjusted for the other variables, between the use of depressogenic medication and a previous admission for depression. No other significant relationships between the use of depressogenic medication and aetiological variables were found. Patients with a first‐time admission for MDD use depressogenic medication 2.44 times more often than patients with previous admissions for depression. Conclusion The use of depressogenic medication is an independent and clinically relevant aetiological factor in MDD. Copyright © 1999 John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 99%

Depressogenic medication as an aetiological factor in major depression: an analysis in a clinical population of depressed elderly people

Dhondt¹,

Derksen²,

Hooijer³

et al. 1999

Int. J. Geriat. Psychiatry

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“…The prescription of a new medication may cause a cascade of successive complications (Harper et al 1989;Irvine 1990). For example, drug-induced 149 depression may result in irritability and poor performance of household chores that contributes to marital discord, with worsening depression.…”

Section: Illness Cascades and Cycles Associated With Depressionmentioning

confidence: 99%

Drug-Induced Depression in the Aged

1993

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Over 10% of medically ill elderly persons have concurrent major depression, and medical illness is the most influential stressor contributing to depression in old age. The contribution of prescribed medications to depression in the medically ill is poorly understood. Most information on drug-induced depression is derived from case reports; 43 classes of medications have been implicated, including reserpine, beta-blockers, levodopa, corticosteroids, and antipsychotics. However, large rigorously performed studies of some drugs, particularly antihypertensives, suggest that drug-induced depression is uncommon and idiosyncratic. There is no evidence that age is an independent risk factor for drug-induced depression. However, elderly persons are the largest consumers of prescribed drugs, and the burden of drug-induced depression is carried by the old. Because of the frequency of atypical presentations of mental disorders in the elderly, drug-induced depression is often misdiagnosed. Nevertheless, basic principles of geriatric medicine offer useful guidance to clinicians in evaluating the complex interrelationships between prescribed medications and depression. We recommend an approach that includes regular inquiry into the common symptoms of mood disorders, vigilance in assessing the contribution of drugs in their development, but scepticism in assessing a depressive episode as caused only by medication.

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“…It still remains unclear whether the use of medication is a significant contributor to the prevalence of old age depression as may be suggested by these shared correlations. Moreover, the elderly are vulnerable to almost all side-effects of drugs because of changes in absorption, metabolism and excretion leading to an elevated drug level and prolonged half-life of the drug (Whitlock and Evans, 1978;Woodet al, 1988;Harper et al, 1989).…”

Section: Depression In the Elderlymentioning

confidence: 99%

Iatrogenic origins of depression in the elderly. Is medication a significant aetiologic factor in geriatric depression? Considerations and a preliminary approach

Dhondt

Hooijer

1995

Int J Geriat Psychiatry

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If depressed mood can occur as a side-effect of drugs prescribed for other purposes, its frequency will rise in the elderly. The significance of this drug associated depression (DAD) in the elderly should be considered. DOES DRUG ASSOCIATED DEPRESSIONEXIST?The first, qualitative question is whether drugs prescribed for other diseases can have depression as a side-effect. Freis (1954) described five cases of DAD following the use of reserpine, one of the first case reports. Further evidence on the probability of a causal relationship emerged in numerous case reports of depression as a side-effect of a specific drug. Part of this evidence depends on a correlation between prevalence of depression and drug use, part on the sequential incidence of prescription of the drug and incidence of depression and part on theoretical pharmacological considerations. This drugoriented approach has converged into an impressive body of knowledge, crystallized in reviews (Ganzini et al., 1993) and pharmacopeia. One prominent representative of this approach is the authoritative book series Meyler's Side Efsects of Drugs (Dukes, 1988) and the Side Efsects ofDrugs Annuals (Dukes, 1989-1 991). Panels of authorities carefully reviewed the existing evidence on side-effects of specific drugs. In about half of the chapters depression is actually mentioned as a side-effect of the drugs reviewed. With the aid of the computerized search program SEDBASE these review texts can be screened (SEDBASE, 1991). In the XIth edition of Meyler's Side Efects of Drugs, with all antidepressants excluded, 121 drugs were found in connection with the key word 'mental depression'. Only 15 of the 12 1 drugs were of minor relevance because of their specific hospital utilization, such as in the intensive care unit.This impressive drug-oriented knowledge points beyond doubt to the qualitative potential of a heterogeneous variety of drugs in the aetiology of depression. However, an extrapolation from these findings to estimate any quantitative contribution of medication to the prevalence of depression in the elderly is hardly feasible. IS THERE CONSENSUS ABOUT THE QUALITATIVE QUESTIONS?To decide whether the co-occurrence of depression is causally attributable to the drug use, one must review and weigh the existing reports of relevant evidence. Instead of reviewing reviews on hundreds of drugs, we screened the results of a similar and better exercise: the text that is presented in pharmacopeia. Of the 121 candidate drugs, selected by using SEDBASE as mentioned above, we excluded 15 drugs because of specific hospital utilization and 28 that are not registered in The Netherlands, and hence less relevant for our purposes. A final list remained of 67 single drugs and 1 1 groups of drugs.To explore the consensus of authoritative opinions, the texts on the 78 items were screened for confirmation in three national pharmacopeia:CCC 0885-6230/95/

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Drug-induced illness in the elderly

Cited by 16 publications

References 55 publications

Depressogenic medication as an aetiological factor in major depression: an analysis in a clinical population of depressed elderly people

Depressogenic medication as an aetiological factor in major depression: an analysis in a clinical population of depressed elderly people

Drug-Induced Depression in the Aged

Iatrogenic origins of depression in the elderly. Is medication a significant aetiologic factor in geriatric depression? Considerations and a preliminary approach

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