Safety of antidepressants in the elderly.
Until the 1980s, the two major classes of antidepressants, the tricyclics and the monoamine oxidase inhibitors (MAOIs), were effective but had severe side effects, requiring monitoring by psychiatrists. The past several years have brought new classes of antidepressants that are safer for the patient to take and far easier for the non-psychiatrist to prescribe. Whilst this is of enormous value, it leaves the physician with the dilemma of which one to prescribe. These new antidepressants cannot safely be used interchangeably. This paper will discuss each of the antidepressants presently available, with particular emphasis on safety in the elderly. Drug interactions, side effects and particular challenges to the older patient will be described. The authors will then advise a general strategy for prescribing antidepressants.
Sommer
Barbara R
BR
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA. brsommer@stanford.edu
Fenn
Howard
H
Pompei
Peter
P
DeBattista
Charles
C
Lembke
Anna
A
Wang
Po
P
Flores
Ben
B
D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D003577:Cytochrome P-450 Enzyme System / Q000502:physiology; D003866:Depressive Disorder / Q000188:drug therapy / Q000378:metabolism; D004347:Drug Interactions; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use
D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D003577:Cytochrome P-450 Enzyme System; D008996:Monoamine Oxidase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors