Late-life depression: rationalizing pharmacological treatment options.
BACKGROUND
Depressive symptoms in late life are a major concern as they increase disability and aggravate existing medical conditions. Depression is underrecognised and undertreated in the elderly, be it due to somatic symptoms, comorbid physical illness or anxiety, or because it is accepted as a normal feature of ageing. There is little doubt that effective and well-tolerated antidepressant therapy is required.


OBJECTIVE
This paper reviews the antidepressant treatment options for late-life depression (selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, mixed noradrenergic and serotonergic agents), in terms of their efficacy, safety and pharmacokinetics in elderly patients.


RESULTS
In addition to proven efficacy, selection of an antidepressant agent for late-life depression must be based on an understanding of safety and pharmacokinetic issues associated with each agent. Comorbid conditions and lifestyle characteristics of the elderly that are different to those encountered in the younger adult population should also be considered.


CONCLUSIONS
To date, published clinical evidence in the elderly suggests that the first-choice agents for treating late-life depression are the SSRIs.
Montgomery
Stuart A
SA
Imperial College School of Medicine, London, UK. stuart@montgomery.demon.co.uk
D000368:Aged / Q000523:psychology*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006801:Humans; D019338:Polypharmacy; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors