title: Prescribing selective serotonin reuptake inhibitors in older age.
abstract: Apart from commercial reasons, two motivations have led to the introduction of SSRIs to replace the first and second generation antidepressants already available. One was the search for a more rational treatment, based on specific mechanisms, the other the development of effective treatments with fewer side effects, particularly for older patients, who have a greater sensitivity to cardio-vascular and central nervous system effects. The first has been frustrated up to a point, in that SSRIs and other single mechanism drugs do not appear to be more effective than the earliest relatively non-specific antidepressants. The second has been fulfilled, in that SSRIs generally are better tolerated in older patients and in overdose. However, there is a spectrum of other side effects that are particularly relevant in older age and that need attention when treating depression in this particular patient group.
authors.affiliation: Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
authors.forename: Anya
authors.initials: A
authors.lastname: Topiwala
authors.affiliation: Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
authors.forename: Leonidas
authors.initials: L
authors.lastname: Chouliaras
authors.affiliation: Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. Electronic address: klaus.ebmeier@psych.ox.ac.uk.
authors.forename: Klaus P
authors.initials: KP
authors.lastname: Ebmeier
mesh_terms: D000368:Aged; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: Antidepressants; CGI; CI; CYP219; Clinical Global Impression (scale); Cytochrome P450 2C19; EPSE; FDA; HAM-D; Hamilton Depression Rating scale; MADRS; MHRA; Major depressive disorder; Medicines and Healthcare products Regulatory Agency; Montgomery-Åsberg Depression Rating scale; NNT; OR; PPIs; QT interval corrected (for heart rate); QTc; RCT; RR; Randomized controlled trials; Risks; SNRI (s); SSRI(s); Side effects; Suicide; TCA(s); US Food and Drug Administration; confidence interval; extrapyramidal side effects; numbers needed to treat; odds ratio; proton pump inhibitors; randomized controlled trial; risk ratio; serotonin reuptake inhibitor(s); serotonin–norepinephrine reuptake inhibitor(s); tricyclic antidepressants(s)