Managing depression and anxiety in the elderly patient.
Depression in the elderly is under-recognised and under-treated, even more than in younger patients. Late-life depression is a chronic and disabling illness, but there is a common misconception that it is a normal feature of ageing. It can also be difficult to differentiate depression from coexisting anxiety and cognitive disorders. Antidepressants are as effective in acute treatment in older, as in younger, depressed adults. Maintenance antidepressant therapy also appears as effective in older patients. It may, however, be difficult to attain therapeutic levels of tricylic antidepressants (TCAs) in the elderly because of side effects. The selective serotonin re-uptake inhibitors (SSRIs) have more favourable safety and tolerability profiles, making them a suitable treatment option for older patients, who are more vulnerable to adverse effects. In selecting an SSRI for treating late-life depression, its pharmacokinetic profile and effects on coexisting illnesses that are prevalent in the elderly, such as anxiety, dementia and cardiovascular disease, also need to be considered.
Katona
C
C
Department of Psychiatry, Royal Free and University College Medical School, Wolfson Building, 48 Riding House Street, London W1N 8AA, UK. c.katona@ucl.ac.uk
D000368:Aged; D000928:Antidepressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D001007:Anxiety / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D006299:Health Services for the Aged; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use*
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors