Use of paroxetine for the treatment of depression and anxiety disorders in the elderly: a review

Chronic obstructive pulmonary disease (COPD) is a serious contemporary health issue. Psychological co-morbidities such as anxiety and depression are common in COPD. Current evidence for treatment options to reduce anxiety and depression in patients with COPD was examined. There is evidence available for the efficacy of pharmacological treatments, cognitive behavioural therapy, pulmonary rehabilitation, relaxation therapy and palliative care in COPD. Therapeutic modalities that have not been proven effective in decreasing anxiety and depression in COPD, but which have theoretical potential among patients, include interpersonal psychotherapy, self-management programmes, more extensive disease management programmes, supportive therapy and self-help groups. Besides pulmonary rehabilitation that is only available for a small percentage of patients, management guidelines make scant reference to other options for the treatment of mental health problems. The quantity and quality of research on mental health treatments in COPD have historically been insufficient to support their inclusion in COPD treatment guidelines. In this review, recommendations regarding assessment, treatment and future research in this important field were made.

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“…Numerous adverse effects from the use of antidepressant therapy have been reported 70,77–82 (Table 3). Serotonin toxicity (symptoms such as, e.g.…”

Section: Treatments For Depression and Anxiety In Copd Patientsmentioning

confidence: 99%

Treatments for anxiety and depression in patients with chronic obstructive pulmonary disease: A literature review

Cafarella¹,

et al. 2012

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“…For example, serotonin may enhance synaptic plasticity by activating cyclic AMP response element-binding protein (CREB) and up-regulating the expression of brain-derived neurotrophic factor (BDNF) (reviewed by Pang and Lu, 2004), and this signaling mechanism may be compromised in AD (Tong et al, 2001). Serotonin-selective reuptake inhibitors are widely prescribed for the treatment of clinical depression and anxiety disorders (Wagstaff et al, 2002;Bourin, 2003), but may also have therapeutic potential as neuroprotective agents (Sanchez et al, 2001;Duan et al, 2004). It was recently reported that environmental enrichment (Lazarov et al, 2004) and dietary restriction (Patel et al, 2005;Wang et al, 2005) can reduce Aβ deposition in APP mutant mice.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic treatment with paroxetine ameliorates behavioral deficits and retards the development of amyloid and tau pathologies in 3xTgAD mice

Nelson

Guo

Halagappa

et al. 2007

Experimental Neurology

163

133

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A history of depression is a risk factor for Alzheimer's disease (AD), suggesting the possibility that antidepressants administered prophylactically might retard the disease process and preserve cognitive function. Here we report that pre-symptomatic treatment with the antidepressant paroxetine attenuates the disease process and improves cognitive performance in the 3xTgAD mouse model of AD. Five month-old male and female 3xTgAD and non-transgenic mice were administered either paroxetine or saline daily for 5 months. Open-field activity was tested in 7 month-old mice and performance in passive avoidance and Morris swim tasks were evaluated at 10 months. 3xTgAD mice exhibited reduced exploratory activity, increased transfer latency in the passive avoidance test and impaired performance in the Morris spatial navigation task compared to nontransgenic control mice. Paroxetine treatment ameliorated the spatial navigation deficit in 3xTgAD male and female mice, without affecting swim speed or distance traveled, suggesting a preservation of cognitive function. Levels of amyloid beta-peptide (Aβ) and numbers of Aβ immunoreactive neurons were significantly reduced in the hippocampus of male and female paroxetine-treated 3xTgAD mice compared to saline-treated 3xTgAD mice. Female 3xTgAD mice exhibited significantly less tau pathology in the hippocampus and amygdala compared to male 3xTgAD mice, and paroxetine lessened tau pathology in male 3xTgAD mice. The ability of a safe and effective antidepressant to suppress neuropathological changes and improve cognitive performance in a mouse model, suggests that such drugs administered prophylactically might retard the development of AD in humans.

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“…In seriously incapacitating cases, when comorbid severe depression is present, and in older adults reluctant to start a psychological treatment, SSRIs can be a suitable alternative. The available data imply that SSRIs are as effective in older adults as in mixed-age populations in reducing anxiety, and that they are generally well-tolerated [20,44]. One recent meta-analysis even suggests that SSRIs may be more effective in reducing late-life anxiety than psychological interventions [26], but as the available research data are scarce and hampered by various methodologic shortcomings, this conclusion is premature.…”

Section: Pharmacologic Interventionsmentioning

confidence: 85%

Late-life Anxiety Disorders: A Review

Schuurmans

Balkom

2011

Curr Psychiatry Rep

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Anxiety disorders are a major clinical problem in late life; estimated prevalence rates vary from 6% to 10%, and the disease impact is considerable and equal to that of depression. However, anxiety disorders often remain undetected and untreated in older adults. This discrepancy may be accounted for by a combination of patient variables (eg, a lack of help-seeking behavior and long duration of illness) and variables related to current clinical practice (eg, a lack of knowledge regarding late-life anxiety and ageism). Because anxiety disorders usually have an age at onset earlier in life, patients and mental health professionals may be inclined to attribute the anxiety and avoidance symptoms to personality factors instead of a treatable syndrome. Comorbidity with other psychiatric disorders, such as depressive disorder, may complicate the appropriate diagnosis. Identification may be further obscured because the phenomenology of anxiety disorders in older adults tends to differ from the phenomenology in younger adults. Randomized controlled trials have yielded support for the effectiveness of cognitive-behavioral therapy and serotonergic antidepressants. However, both treatments seem hampered by relatively high dropout rates, and the available data are based primarily on a relatively healthy, well-educated, and "young" older population. The dissemination of knowledge regarding late-life anxiety disorders is vital, as evidence-based treatments are available but are still rarely implemented.

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Use of paroxetine for the treatment of depression and anxiety disorders in the elderly: a review

Cited by 23 publications

References 39 publications

Treatments for anxiety and depression in patients with chronic obstructive pulmonary disease: A literature review

Treatments for anxiety and depression in patients with chronic obstructive pulmonary disease: A literature review

Prophylactic treatment with paroxetine ameliorates behavioral deficits and retards the development of amyloid and tau pathologies in 3xTgAD mice

Late-life Anxiety Disorders: A Review

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