The Critical Role of Clinical Pharmacology in Geriatric Psychopharmacology

Abstract

There is limited geriatrics‐oriented clinical pharmacological information available to guide pharmacotherapy in late‐life psychiatric disorders. In this paper, we review available data on interindividual differences in drug exposure and central nervous system functioning, amplified by drug–drug interactions in the elderly, that may contribute to variable responses to treatment and significant adverse drug effects. The inclusion of greater numbers of elderly persons in clinical trials and the vigorous application of clinical pharmacologic methodology (i.e., pharmacoepidemiology, population pharmacokinetic modeling, and pharmacogenetics) will be critical for improving safety and personalization of drug and dose selection for elderly patients. Clinical Pharmacology & Therapeutics (2008); 85, 1, 89–93 doi:

Use of Lithium in the Treatment of Bipolar Disorder in Late-Life

“…Here the current evidence on the use of lithium in the acute and maintenance treatment of older patients with bipolar disorder is reviewed systematically, with a focus on the literature of the past 3 years. Age-related pharmacokinetic and pharmacodynamic changes and their effects on lithium use are highlighted [14]. Finally, the impact of lithium on cognition and suicide among older adults is evaluated.…”

Psychotropic Drug Prescribing Survey in a Canadian Rehabilitation and Complex Care Facility

“…The elderly are particularly vulnerable to serious side effects of these medications because of comorbidities, age-related changes in drug distribution and metabolism, heightened neurotransmitter receptor sensitivity, and drug interactions associated with polypharmacy. 1 The risk of falls is of particular concern in the elderly population. Side effects of psychotropic medications have been linked to increased risk of falls.…”

Contemporary Therapies for Depression in Older People

“…Conversely, depression can worsen the course of comorbid medical illness, and is a risk factor for increased morbidity and functional disability, as well as a risk factor for mortality in medically hospitalised and nursing home patients. 5,7,10 Many medications used in the elderly are associated with precipitating or exacerbating depression. 11,12 For example, systemic corticosteroids, antihypertensives (e.g.…”

“…[4][5][6] Along with these issues, the specific complex factors associated with old age, such as the presence of multiple comorbidities, physical disability and polypharmacy, impact on the effective treatment of depression. 7 Independent of physical problems, depression in the elderly is slower to respond to treatment than younger individuals. 8 Frequently, there is only partial response to treatment and in some cases non-response, which adds an increased level of complexity in the management of older people with depression.…”