Archive for the 'Elderly' Category

05 Nov

Use of SSRIs in the elderly: ADVANTAGES(2)

In a recent randomized, double-blind study that included many elderly patients with ischemic heart disease, nortriptyline was compared with paroxetine. Both treatments were equally efficacious, though more patients taking nortriptyline dropped out prematurely and had ad verse cardiac events that resulted in termination. Finally, from a practical perspective, the SSRIs relatively flat dose-response curves make […]

04 Nov

Use of SSRIs in the elderly: ADVANTAGES(1)

While the present review has focused on potential disadvantages of SSRIs, there are also clearly significant advantages for the elderly patient. Anticholinergic effects of TCAs such as dry mouth, blurred vision, constipation, urinary retention and confusion have often been rate-limiting factors in their use in the elderly. In vitro receptor binding studies have shown that […]

03 Nov

Use of SSRIs in the elderly: UNAPPRECIATED RISKS(3)

Given the prevalence of polypharmacy and the multiple comorbid medical illnesses that appear to characterize depression in late life, an antidepressant’s potential for drug interactions becomes exceedingly important. Numerous reviews have highlighted both potential concerns based on in vitro studies, as well as actual drug interactions from clinical samples and in vivo pharmacodynamic studies. The […]

02 Nov

Use of SSRIs in the elderly: UNAPPRECIATED RISKS(2)

Another potential cause of falls and/or delirium in the elderly may be SSRI-induced hyponatremia. In a retrospective review of 1905 psychiatric inpatients, 3.4% developed significant hyponatremia, defined as serum sodium less than 130 mmol/L . In a univariate analysis, older age, female sex and fluoxetine use were the statistically significant variables. In a logistic regression […]

01 Nov

Use of SSRIs in the elderly: UNAPPRECIATED RISKS(1)

SSRIs lack alpha-adrenergic blockade, thus reducing the potential for orthostatic hypotension, potentially eliminating the serious consequences of falls. Unfortunately, this theoretical advantage may not translate into clinical reality. In an interesting preliminary study by Laghrissi-Thode et al , three groups of subjects were studied to determine the effects of antidepressant treatment in elderly patients by […]

31 Oct

Use of SSRIs in the elderly: COMPARATIVE EFFECTIVENESS

While efficacy refers to how well the drug works under ideal conditions, effectiveness refers to how well the drug works in the usual clinical setting. A recent pharmacoepidemiologi-cal study conducted over a three-year period in a university outpatient clinic assessed the comparative effectiveness of SSRIs and TCAs in 213 patients, with an average age of […]

30 Oct

Use of SSRIs in the elderly: COMPARATIVE EFFICACY

Since this meta-analysis, there has only been one additional double-blind, randomized, controlled trial published that compared sertraline with nortriptyline . This report of a 12-week study of 76 patients, aged 70 to 89 years, was actually a subpopulation of a larger study of geriatric outpatients (unpublised data). The results suggested that sertraline was significantly better […]

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