Pharmacokinetics of tricyclic and related antidepressants

Crome, Peter; Dawling, Sheila

doi:10.1007/978-1-4899-3436-9_8

Cited by 5 publications

(4 citation statements)

References 70 publications

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“…Age-related changes result in a prolonged halflife and higher steady state plasma concentrations of tricyclics and mianserin (Crome and Dawling, 1989;Montgomery, 1990). Blood levels in the proposed therapeutic range can be achieved with mean daily doses of only 60 mg amitriptyline when given to elderly inpatients (Crome and Dawling, 1989). It may be that some GPs in Sydney believe that, because of age-related changes, their patients reach recommended blood levels of tricyclics or mianserin on relatively small doses.…”

Section: Use Of Antidepressantsmentioning

confidence: 99%

“…'s (1981) study, only one of the five responders reached a plasma concentration in the proposed therapeutic range and none of Lakshmanan et al3 (1986) responders had serum levels above 20 ng/ml. Good reasons have been given for using much smaller doses (half or less of the standard recommended adult dose) when starting elderly people on antidepressants (Crome and Dawling, 1989). However, we believe it important to stress that a 'Start low, go slow' policy should not lead to prolonged low dosage unless (1) side-effects develop with higher dosage, or (2) low dosage results in recovery.…”

Section: Use Of Antidepressantsmentioning

confidence: 99%

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Use of antidepressants, and the prevalence of depression and cognitive impairment in Sydney nursing homes

Snowdon¹,

Burgess²,

Vaughan³

et al. 1996

Int. J. Geriat. Psychiatry

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In 1993, a survey was conducted in 46 of the 47 nursing homes in a health district of Sydney. Medication cards and notes of all residents (N = 2414) were studied. Subjects who were willing and able to answer questions were interviewed by research assistants (senior nurses). Using the Mini‐Mental State Examination and Mental Status Questionnaire, about 80% were found to be cognitively impaired. Of 874 subjects assessed with the Geriatric Depression Scale (GDS), 30.4% scored in the clearly depressed range (14 or more) of whom 27.4% were taking antidepressants. From a subsample of 26 with GDS scores of 14+, the psychiatrist concluded that only one‐third would fulfil DSM‐III‐R criteria for major depression, with or without dementia. The dosages of antidepressants used in these nursing homes were relatively low. Of residents taking a tricyclic or mianserin, 48% were taking less than 30 mg daily, even though in 72% of cases their doctors stated the primary reason they were having this medication was to treat or prevent recurrence of depression. Opinions and evidence concerning the efficacy of such low dosage are conflicting. There is a need for further research, including correlation of efficacy with blood levels of antidepressants.

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Section: Use Of Antidepressantsmentioning

confidence: 99%

Section: Use Of Antidepressantsmentioning

confidence: 99%

Use of antidepressants, and the prevalence of depression and cognitive impairment in Sydney nursing homes

Snowdon¹,

Burgess²,

Vaughan³

et al. 1996

Int. J. Geriat. Psychiatry

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show abstract

“…There is also some preliminary evidence from a kinetic study in the elderly 57 that, for citalopram, lower doses are recommended in the elderly because of the prolonged half‐life. In contrast, special dosing adjustments for fluvoxamine and sertraline may not be required in older patients as plasma levels are not affected by age 8,58 . Further studies on the dosage requirement of antidepressants in the elderly are needed to throw light on this important topic.…”

Section: The Drugsmentioning

confidence: 99%

Antidepressants in the Elderly

Chiu

1997

Int J Clinical Practice

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SUMMARYAntidepressants are effective in the treatment of depression but their use in the elderly merits special attention. In general, the tertiary amine tricyclic antidepressants (TCAs) tend to produce significant side‐effects in the elderly. In contrast, nortriptyline, desipramine and lofepramine are better tolerated than other TCAs. The newer antidepressants including the selective serotonin reuptake inhibitors are useful alternatives in the treatment of depression in the elderly. As pharmacokinetic studies show that higher steady‐state plasma levels of tertiary amine antidepressants may be found in the elderly than in the younger population, a lower dosage is recommended. However, the need for a lower dose in the elderly is less certain for the secondary amine TCAs. The optimum duration of continuation and maintenance antidepressant therapy requires further study. For delusional depression, there is evidence to support the superiority of ECT and combination antipsychotic/antidepressant treatment over antidepressant alone. The ultimate choice of antidepressant will be a balance of efficacy, safety, acceptability and cost.

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“…The chieffeatures regarded here are: a) absorption, b) distribution, c) metabolism, and d) excretion (Crome and Dawling, 1989;Braithwaite, 1982). An these processes may be affected in the elderly but the degree to which they are affected greatly varies in the individual cases.…”

Section: Particular Pharmacokinetic Featuresmentioning

confidence: 99%

Antidepressant Drug Therapy in the Elderly - A Critical Review of the Controlled Clinical Trials Conducted since 1980

Hp¹,

Møller²

1994

Pharmacopsychiatry

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We report on the results of controlled clinical antidepressant trials with elderly depressed patients which meet certain methodological requirements and have been published since 1980. The safety, tolerability, and efficacy of the investigated compounds are reviewed. In the light of the diagnostic problems and the altered pharmacokinetic behavior in this special age group we conclude that the progress in scientific knowledge in the last 13 years has only been moderate.

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Pharmacokinetics of tricyclic and related antidepressants

Cited by 5 publications

References 70 publications

Use of antidepressants, and the prevalence of depression and cognitive impairment in Sydney nursing homes

Use of antidepressants, and the prevalence of depression and cognitive impairment in Sydney nursing homes

Antidepressants in the Elderly

Antidepressant Drug Therapy in the Elderly - A Critical Review of the Controlled Clinical Trials Conducted since 1980

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