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Pharmacological treatment of depression in older people

Curran, Stephen, Byrne, Andrew and Wattis, John (2006) Pharmacological treatment of depression in older people. Mental Health and Learning Disabilities Research and Practice, 3 (1). pp. 63-85. ISSN 1743-6885

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    In the light of recent National Institute for Clinical Excellence (NICE) and Committee for the Safety of Medicines (CSM) guidance we discuss the importance of the diagnosis of depression in old age and review pharmacological interventions. An introductory section is followed by sections on each of the main antidepressant groups. This briefly describes their pharmacology and reviews research done specifically relevant to older people. Finally practical clinical applications are discussed.

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    Item Type: Article
    Uncontrolled Keywords: pharmacological treatment; depression; older elderly people
    Subjects: R Medicine > R Medicine (General)
    R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
    Schools: School of Human and Health Sciences
    School of Human and Health Sciences > Ageing and Mental Health Research Group
    Related URLs:

    Abou-Saleh, M.T. & Coppen A. 1983. The prognosis of depression in old
    age: the case for lithium therapy. British Journal of Psychiatry,; 170, 285-
    Aguglia, E. 2000. Reboxetine in the maintenance therapy of depressive
    disorder in the elderly: a long-term open study International Journal of
    Geriatric Psychiatry, 15, 784-93..
    Akiskal, H.S. 1985. An approach to chronic and ‘resistant’ depressions:
    evaluation and treatment. Journal of Clinical Psychiatry,; 46, 32-36.
    Alexopoulous, G.S. 1992. Geriatric depression reaches maturity.
    International Journal of Geriatric Psychiatry, 7, 305-306.
    Ames, D., Ashby, D., Mann, A.H. & Graham, N. 1988. Psychiatric illness in
    elderly residents of part 3 homes in one London borough: prognosis and
    review. Age and Ageing, 17(4), 249-256.
    Anderson, I. & Edwards, J. 2001. Guidelines for choice of selective
    serotonin reuptake inhibitor in depressive illness. Advances in Psychiatric
    Treatment,, 7, 170-180.
    Anderson, I.M., Nutt, D.J., & Deakin, J.F.W. 2000. Evidence-based
    guidelines for treating depressive disorders with antidepressants; a revision
    of the 1993 British Association for Psychopharmacology guidelines. Journal
    of Psychopharmacology, 14(1), 3-20.
    Anderson, I.M. 2001. Meta-analytical studies on new antidepressants.
    British Medical Bulletin, 1, 161-178.
    Angst, J. 1997. A regular review of long term follow-up of depression.
    British Medical Journal, 315, 1143-1146.
    Appelberg, B. 2002. Long-term citalopram prevents recurrent depression in
    the elderly and is well tolerated. Evidence Based Mental Health, 6(1):24.
    Ariyo, A.A., Haan, M., Tangen, C.M. et al. 2000. Depressive symptoms and
    risks of coronary heart disease and mortality in elderly Americans.
    Circulation, 102, 1773-1779.
    Aronson, R., Offman, H.J., Joffe R.T. & Naylor, C.D. 1996. Triiodothyronine
    augmentation in the treatment of refractory depression. A meta-analysis.
    Archives of General Psychiatry, 53, 842-848.
    Austin, M.P.V., Souza, F.G.M. & Goodwin, G.M. 1991. Lithium
    augmentation in antidepressant-resistant patients: a quantitative analysis.
    British Journal of Psychiatry,159, 510-14.
    Baldwin, R.C. 1996. Treatment resistant depression in the elderly: a review
    of treatment options. Reviews in Clinical Gerontology, 6, 343-348.Baldwin, R.C., Chiu, E, Katona, C, & Grahaam, N. 2002. Guidelines on
    Depression in Older People: practising the evidence. Martin Dunitz,
    Barak, Y., Swartz, M., Levy, D. et al. 2003. Age-related differences in the
    side-effect profile of citalopram. Progress in Neuropsychopharmacology
    and Biological Psychiatry, 27(3), 545-548.
    Barbui, C. & Hotopf, M. 2001. Amitriptyline versus the rest; still the leading
    antidepressant after 40 years of randomised controlled trials. British Journal
    of Psychiatry, 178, 129-144.
    Baumann, P. 1998. Care of depression in the elderly: comparative
    pharmacokinetics of SSRIs. International Clinical Psychopharmacology, 13
    (suppl.5), 35-43.
    N. F. N. Bergmann, J.F., Laneury, J.P., Duchene, P., Fleishaker, J.C.,
    Houin, G & Segrestaa, J.M. 2000. Pharmacokinetics of reboxetine in
    healthy, elderly volunteers. European Journal of Drug Metabolism &
    Pharmacokinetics, 25(3-4), 195-198.
    Bielski, R., Ventura, D. & Chung-Chi C. 2003. A double-blind comparison of
    escitalopram with venlafaxine XR in the treatment of major depressive
    disorder. 16th Congress of the European College of
    Neuropsychopharmacology, Prague, 20-24, September 2003.
    Bodani, M. Sheehan, B. & Philpot M. 1999. The use of dexamethasone in
    elderly patients with antidepressant–resistant depressive illness. Journal of
    Psychopharmacology, 13(2), 196-197.
    Bonnet, U. 2003. Moclobemide; therapeutic use and clinical studies. CNS
    Drug Reviews, 9(1), 97-140.
    Bowskill, R.J. & Bridges, P.L. 1997. Treatment-resistant affective disorders.
    British Journal of Hospital Medicine, 57, 171-172.
    Committee on Safety of Medicines 2004. Report of the CSM Expert
    Working Group on the Safety of Selective Serotonin reuptake Inhibitors
    Antidepressants, December 2004,
    Committee on Safety of Medicines 2004. Safety of Selective Serotonin
    Reuptake Inhibitor Antidepressants.
    Cowen, P.J. 1998. Pharmacological management of treatment-resistant
    depression. Advances in Psychiatric Treatment,,4, 320-327.
    Cujpers, P. 1998. Psychological outreach programmes for the depressed
    elderly: A meta-analysis of effects and dropout. International Journal of
    Geriatric Psychiatry, 13(1), 41-48.
    Curran, S. 1995. Effect of paroxetine on seizure length during
    electroconvulsive therapy. Acta Psychiatrica Scandinavica, 12(2), 239-240.Curran, S. & Wattis, J.P. 2004. Psychopharmacology in the elderly. In:
    Seminars in Clinical Psychopharmacology (Ed. D.J King), 2nd Edition,
    Gaskell, London, 447-484.
    Curran, S, Nightingale, S. & Wattis, J.P. 2005. Practical issues in assessing
    and prescribing psychotropic drugs in older people. In: Practical Old Age
    Psychopharmacology; A Multi-Professional Approach, S Curran and R
    Bullock (Eds.), Radcliffe Medical, Oxford, 47-72.
    Danjou, P. & Hackett D. 1995. Safety and tolerance profile of venlafaxine.
    International Clinical Psychopharmacology,, 10 (Suppl.2), 15-20.
    Donoghue, J. & Hylan, T.R. 2001. Antidepressant use in clinical practice;
    efficacy versus effectiveness. British Journal of Psychiatry, 179 (Suppl.42),
    Dwyer, M. & Byrne, G.J. 2000. Disruptive vocalisation and depression in
    older nursing home residents. International Psycho geriatrics, 12, 463-471.
    Einarson, T.R., Arikian, S.R,. Casciano, J. & Doyle, J.J. 1999. Comparison
    of extended release Venlafaxine, selective serotonin re-uptake inhibitors,
    and tricyclic antidepressants in the treatment of depression: a metaanalysis
    of randomised controlled trials. Clinical Therapeutics, 21, 296-308.
    Emptage, R.E., Semla, T.P., Gonzales, L. & Larouche, M. 1996.
    Depression in the medically ill elderly: A focus on methylphenidate. Annals
    of Pharmacotherapy, 30(2), 151-157.
    Everybody's Business. Integrated mental health service for older adults: a
    service development guide 2005. Care Services Improvement Partnership/
    Department of Health, London:
    Fahy, S. & Lawlor BA. 2001. Discontinuation of lithium augmentation in an
    elderly cohort. International Journal of Geriatric Psychiatry, 16(10), 1004-
    Flint, A.J. 2002. Treatment-resistant depression in late life. CNS
    Spectrums, 7(10), 733-738.
    Flint, A.J. & Rifat, S.L. 1996. The effect of sequential antidepressant
    treatment on geriatric depression. Journal of Affective Disorders, 36, 95-
    Flint, A J. 1992. The optimum duration of antidepressant treatment in the
    elderly. International Journal of Geriatric Psychiatry, 7, 617-619.
    Flint, A.J., Rifat, S.L. 1994. A prospective study of lithium augmentation in
    antidepressant-resistant geriatric depression. Journal of Clinical
    Psychopharmacology, 14, 353-356.
    Furukawa, T., McGuire, H. & Barbui C 2004. Low dosage tricyclic
    antidepressants for depression. Cochrane Review 3,.Georgotas, A. & McCue, R. 1989. The additional benefit of extending an
    antidepressant trial past seven weeks in the depressed elderly.
    International Journal of Geriatric Psychiatry, 4, 191-195.
    Georgotas, A.M.R., Cooper, T. 1989. Factors affecting the delay of
    antidepressant effect in responders to nortriptyline and phenelzine.
    Psychiatry Research, 28, 1-9.
    Glassman, A.H., O’Connor, C.M., Califf, R.M., Swedberg, K. et al. 2002.
    Sertraline treatment of major depression in patients with acute MI or
    unstable angina. Journal of the American Medical Association, 288(6), 701-
    Guaiana, G., Barbui, C. & Hotopf, M. 2004. Amitriptyline versus other types
    of pharmacotherapy for depression. Cochrane Review 3.
    Guscott, R. & Grof. P. 1991. The clinical meaning of refractory depression:
    a review for the clinician. American Journal of Psychiatry, 148, 695-704.
    Hale, A, Proctor, A.W. & Bridges, P.K. 1987. Clomipramine, tryptophan and
    lithium in combination for resistant endogenous depression seven case
    studies. British Journal of Psychiatry, 151, 213-217.
    Halikas, J.A. 1995. Org 3770 (mirtazapine) versus trazodone; a placebo
    controlled trial in depressed elderly patients. Human Psychopharmacology,;
    10, 125-133.
    Hindmarch, I. 2001. Expanding the horizons of depression; beyond the
    monoamine hypothesis. Human Psychopharmacology, 16(3), 203-218.
    Hoencamp, E., Haffmans, P.M.J., Dijken, W.A., et al. 2000. Lithium
    augmentation of venlafaxine: an open-label trial. Journal of Clinical
    Psychopharmacology, 20, 538-543.
    Hoyberg, O.J., Maragakis, B., & Mullin, J. et al. 1996. A double-blind multicentre
    comparison of mirtazapine and amitriptyline in elderly depressed
    patients. Acta Psychiatrica Scandinavica, 93, 184-190.
    Hudson, J.I., Wohlreich, M.M., Kajdasz, D.K. et al. 2005. Safety and
    tolerability of duloxetine in the treatment of major depressive disorder; an
    analysis of pooled data from eight placebo-controlled clinical trials. Human
    Psychopharmacology, 20, 327-341.
    Jonas, B.S. & Mussolino, M. E. 2000. Symptoms of depression as a
    prospective risk factor for stroke. Psychosomatic Medicine, 62, 463-471.
    Kalayam, B. & Alexopoulos, G.S. 1999. Prefrontal dysfunction and
    treatment response in geriatric depression. Archives of General Psychiatry,
    56(8), 713-718.
    Katona, C., Bercoff, E., Chiu, E., Tack, P., Versiani, M. & Woelk, H. 1999.
    Reboxetine versus imipramine in the treatment of elderly patients with
    depressive disorders; a double-blind randomised trial. Journal of Affective
    Disorders, 55, 203-213.Kirby, D., Harrigun, S. & Ames, D. 2002. Hyponatraemia in elderly
    psychiatric patients treated with SSRIs and venlafaxine: a retrospective
    controlled study in an in-patient unit. International Journal of Geriatric
    Psychiatry,; 17, 231-7.
    Koenig, H.G., Meador, K. G., Cohen, H.J. & Blazer, D. 1988. Depression in
    elderly hospitalised patients with medical illness. Archives of Internal
    Medicine, 148, 1929-1936.
    Krystal, A.D., Coffey, C.E., Weiner, R.D. & Holsinger, T. 1998. Changes in
    seizure threshold over the course of electroconvulsive therapy affect
    therapeutic response and are detected by ictal EEG ratings. Journal of
    Neuropsychiatry & Clinical Neurosciences, 10(2), 178-186.
    Laidlaw, K, Thompson, L.W., Dick-Siskin, L. & Gallagher-Thompson, D.
    2003. Cognitive Behaviour Therapy with Old People. John Wiley & Sons,
    Li, Y.S., Meyer, J.S. & Thornby, J. 2001. Longitudinal follow-up of
    depressive symptoms among normal versus cognitively impaired elderly.
    International Journal of Geriatric Psychiatry, 16(7), 718-727.
    Mahapatra, S.N. & Hackett, D. 1997. A randomised, double-blind, parallelgroup
    comparison of venlafaxine and dothiepin in geriatric patients with
    major depression. International Journal of Clinical Practice, 51(4). 209-213.
    Mendlewicz, J. 1995. Pharmacologic profile and efficacy of venlafaxine.
    International Clinical Psychopharmacology, 10 (Suppl.2), 5-13.
    Mendlewicz, J. 2001. Optimising antidepressant use in clinical practice;
    towards criteria for antidepressant selection. British Journal of Psychiatry,
    179 (Suppl. 42), 1-3.
    Mittman, N., Herrmann, N., Einarson, T.R. et al. 1997. The efficacy, safety
    and tolerability of antidepressants in late life depression: a meta-analysis.
    Journal of Affective Disorders, 46, 191-217.
    Moreno, F.A., Gelenberg, A.J., Bachar, K. & Delgado, P.L. 1997. Pindolol
    augmentation of treatment-resistant depressed patients. Journal of Clinical
    Psychiatry, 58(10), 437-439.
    Morishita, S., Aoki, S. 1999. Clonazepam in the treatment of prolonged
    depression. Journal of Affective Disorders, 53(3), 275-278.
    Mottram, P, Wilson, K.C.M., Ashworth, L. & Abou-Saleh, M. 2002. The
    clinical profile of older patients' response to antidepressants - an open trial
    of sertraline. International Journal of Geriatric Psychiatry, 17, 574-578.
    Navarro, V., Gasto, C., Torres, .X, Marcos, T. & Pintos, L. 2001. Citalopram
    versus nortriptyline in late-life depression: A 12 week randomized singleblind
    study. Acta Psychiatrica Scandinavica, 103(6), 435-440.
    National Institute for Clinical Excellence 2004. Depression: Management of
    Depression in Primary and Secondary Care, Clinical Guideline 23,
    December, London.Nelson, J.C., Wohlreich, M.M., Mallinckrodt, C.H. et al. 2005. Duloxetine for
    the treatment of major depressive disorder in older people. American
    Journal of Geriatric Psychiatry, 13(3), 227-235.
    Nierenberg, A.A., Feighner, J.P., Rudolph, R. et al. 1994. Venlafaxine for
    treatment-resistant unipolar depression. Journal of Clinical
    Psychopharmacology, 14, 419-423.
    2000. Neuroimaging in dementia and
    Old Age Depression Interest Group 1993. How long should the elderly take
    antidepressants? A double-blind placebo-controlled study of
    continuation/prophylaxis therapy with dothiepin. British Journal of
    Psychiatry, 162, 75-182.
    Oslin, D.W., Have, T.R.T. & Streim, J.E. et al.2003. Probing the safety of
    medications in the frail elderly; evidence from a randomised clinical trial of
    sertraline and venlafaxine in depressed nursing home residents. Journal of
    Clinical Psychiatry, 64(8), 875-882.
    Penninx, B.W., Deeg, D.J., van Eijk, J.T. et al. 2000. Changes in
    depression and physical decline in older adults; a longitudinal perspective.
    Journal of Affective Disorders, 61, 1-12.
    Pridmore, S. & Turnier, S.Y. 2004. Medication options in the treatment of
    treatment-resistant depression. Australian and New Zealand Journal of
    Psychiatry, 38(4), 219-225.
    Rapaport,M.H., Schneider, L.S., Dunner, D.L. et al. 2003. Efficacy of
    controlled-release paroxetine in the treatment of late-life depression.
    Journal of Clinical Psychiatry, 64(9), 1065-1074.
    Renwick, R.A. 1985. Treatment resistant depression. Psychiatric Journal of
    University of Ottawa, 46, 576-584.
    Reynolds, C.F., III, Perel, J.M. & Frank E, et al. 1999. Three-year outcomes
    of maintenance nortriptyline treatment in late-life depression: a study of two
    fixed plasma levels. American Journal of Psychiatry, 156(8), 1177-1181.
    Roth, M., Montjoy, C. & Amrein, R. 1996. Moclobemide in elderly patients
    with cognitive decline and depression: an international double–blind trial,
    placebo-controlled trial. British Journal of Psychiatry, 168(2), 149-157.
    Schatzberg, A.F., Kremer, C., Rodrigues, H.E., Murphy & G.M. et al. 2002.
    Double-blind, randomised comparison of mirtazapine and paroxetine in
    elderly depressed patients. American Journal of Geriatric Psychiatry, 10(5),
    Shapira, B., Tub,i N., Drexler, H., Lidsky, D., Calev, A. & Lerer, B. 1998.
    Cost and benefit in the choice of ECT schedule. Twice versus three times
    weekly ECT. British Journal of Psychiatry, 172, 44-48.Sheikh, J..I, Cassidy, E.L., Doraiswamy, P.M. et al. 2004. Efficacy, safety
    and tolerability of sertraline in patients with late-life depression. Journal of
    the American Geriatrics Society, 52(1). 86-92.
    Smith, D., Dempster, C., Glanvile, J. et al. 2002. Efficacy and tolerability of
    venlafaxine compared with selective serotonin reuptake inhibitors and other
    antidepressants; a meta-analysis. British Journal of Psychiatry, 180, 396-
    Stah,l S. & Briley, M. 2004. Understanding pain in depression. Human
    Psychopharmacology, 19, S9-S13.
    Stahl, S 2000. Essential Psychopharmacology; Neuroscientific Basis and
    Practical Applications. Second Edition, Cambridge, CUP.
    Stahl, S.M. 1998. Basic psychopharmacology of antidepressants part 2:
    oestrogen as an adjunct to antidepressant treatment. Journal of Clinical
    Psychiatry, 59(4), 15-24.
    Thase, M.E. & Rush, A.J. 1997. Treatment resistant depression. In: Bloom
    FEaKD, editor. Psychopharmacology: The Fourth Generation of Progress.
    New York: Raven Press, 1081-1215.
    Thase, M.E., Entsuah, R. & Rudolph, R.L. 2001. Remission rates during
    treatment with venlafaxine or selective serotonin reuptake inhibitors. British
    Journal of Psychiatry, 178, 234-241.
    Timmer, .CL., Paanakker, J.E. & van Hal, H.J.M. 1996. Pharmacokinetics
    of mirtazapine from orally administered tablets: influence of age, gender
    and treatment regimen. Human Psychopharmacology, 11, 497-509.
    Tourigny-Rivard, M.F. 1997. Pharmacotherapy of affective disorders in old
    age. Canadian Journal of Psychiatry, 42 (1)

    Depositing User: Sara Taylor
    Date Deposited: 17 Apr 2008 15:02
    Last Modified: 16 Aug 2013 13:19


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