Late-Life Depression: Rationalizing Pharmacological Treatment Options

Abstract

Background: Depressive symptoms in late life are a major concern as they increase disability and aggravate existing medical conditions. Depression is underrecognised and undertreated in the elderly, be it due to somatic symptoms, comorbid physical illness or anxiety, or because it is accepted as a normal feature of ageing. There is little doubt that effective and well-tolerated antidepressant therapy is required. Objective: This paper reviews the antidepressant treatment options for late-life depression (selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, mixed noradrenergic and serotonergic agents), in terms of their efficacy, safety and pharmacokinetics in elderly patients. Results: In addition to proven efficacy, selection of an antidepressant agent for late-life depression must be based on an understanding of safety and pharmacokinetic issues associated with each agent. Comorbid conditions and lifestyle characteristics of the elderly that are different to those encountered in the younger adult population should also be considered. Conclusion: To date, published clinical evidence in the elderly suggests that the first-choice agents for treating late-life depression are the SSRIs.

Structured reminiscence: an intervention to decrease depression and increase self‐transcendence in older women

“…2002). Likewise, older people tend to have decreased medication compliance and are more likely to experience drug overdose (Montgomery 2002). For these reasons, there is a need to research alternative therapies for treatment of depression in the older female.…”

Antidepressant Response Trajectories and Associated Clinical Prognostic Factors Among Older Adults

“…Although both sophisticated and important, previous applications of group-based longitudinal methods to study treatment response have been either: large but not restricted to older adults (predominately including middle-aged adults) 4–6 , small plus not restricted to older adults 7 , or small/not restricted to solo pharmacologic treatment 8,9 . Compared with younger adults, factors including pre-treatment co-morbidity 12 and polypharmacy 13 may contribute to an altered course of pharmacologic treatment and response in LLD 14–16 . Variability in neuropsychological function among older adults also predicts treatment outcomes 17–19 .…”

Sensible prescribing for older people

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