Antidepressants for Elderly People

Depression is one of the commonest problems in old age. Yet until recently, old people were systematically exduded from participating in drug trials and similar investigations. As a result, knowledge regarding incidence, natural history and management of depression in the elderly are somewhat limited. It is now well-established that old people are sensitive to most psychotropic drugs and they tend to suffer from adverse effects and side effects of antidepressant drugs more frequently than any other age group. These are considered to be due to age-related physiological changes. In addition, because of the frequent association with multiple pathology, the elderly are likely to receive polypharmacy which further complicates the management of antidepressant drug therapy. The aim of this book is to provide a comprehensive guidance on the drug therapy of depression for the dinicians involved in the health care of the elderly. In the first section, epidemiology, presentations and assessment of depression in old age and neuroendocrine abnormalities observed in patients with depression are briefly discussed. However, it mainly deals with the problems of antidepressant drug therapy, such as which antidepressant to prescribe, how to monitor efficacy and side effects, what is the adequate dose, how long to treat a single episode of depression and who requires long term medication. Information regarding pharmacology, side effects, adverse effects, drug interaction and pharmacokinetics of most currently available drugs are provided. Special emphasis has been given on continuation therapy and the choice of an antidepressant drug and their long term safety. Front Matter....Pages i-x Front Matter....Pages 1-1 Presentation and assessment of depression in old age....Pages 3-11 Identification of depression in geriatric medical patients....Pages 13-25 The epidemiology and natural history of depression in old age....Pages 27-42 Neuroendocrine abnormalities in depression and the influence of drugs....Pages 43-63 Front Matter....Pages 65-65 Metabolic and endocrine effects of lithium....Pages 67-83 Clinical pharmacology of lithium salts....Pages 85-102 Lithium in the prophylaxis of depressive illness in late life....Pages 103-114 Front Matter....Pages 115-115 Pharmacokinetics of tricyclic and related antidepressants....Pages 117-136 Which antidepressant?....Pages 137-162 Cardiovascular effects of tricyclic antidepressants in elderly people....Pages 163-179 Side-effects of tricyclic and related antidepressants....Pages 181-198 Front Matter....Pages 199-199 Efficacy and problems of MAO inhibitor antidepressants....Pages 201-216 Front Matter....Pages 217-217 Management of acute episodes of depression....Pages 219-233 The use of electroconvulsive therapy in elderly depressive patients....Pages 235-251 Drug therapy in the management of treatment-resistant depression in elderly people....Pages 253-268 Long-term antidepressant treatment in old age....Pages 269-277 Factors influencing the outcome of treatment....Pages 279-290 Back Matter....Pages 291-302