Pharmacotherapy of major depression in late life: what is the role of new agents?
Evidence on the pharmacotherapy of late-life major depressive disorder (LLD) is scant. Most of the recommendations in existing clinical guidelines are based on expert opinions, extrapolations from data obtained in younger patients, or theoretical considerations. Areas covered: This article summarizes the recommendations from existing clinical guidelines and recent reviews on the treatment of LLD. Next, it discusses the potential role of newer antidepressants - vilazodone, levomilnacipran, and vortioxetine - based on a systematic search of the literature published during the past five years. Then, it presents evidence pertaining to the use of ketamine, aripiprazole, brexpiprazole, quetiapine, and methylphenidate in the treatment of LLD. Expert opinion: Very few recent publications directly relevant to the pharmacotherapy of LLD were identified: there are no published data supporting the use of vilazodone, levomilnacipran, ketamine, or brexpiprazole in older patients. Recent placebo-controlled randomized controlled trials (RCTs) support the use of vortioxetine, quetiapine monotherapy, aripiprazole augmentation, or methylphenidate augmentation (with one RCT for each). Thus, overall, there have been few innovations in the pharmacotherapy of LLD over the past decade and the stepwise approach recommended in older guidelines remains relevant today. More studies addressing the relative efficacy, tolerability, and safety of psychotropic medications are needed.
a Centre for Addiction and Mental Health , Toronto , ON , Canada.
Kinjal
K
Patel
b Department of Psychiatry , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.|c Outpatient Geriatric Mental Health Services , Centre for Addiction and Mental Health , Toronto , ON , Canada.
Petal S
PS
Abdool
b Department of Psychiatry , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.|d Division of Geriatric Mental Health , Centre for Addiction and Mental Health , Toronto , ON , Canada.
Tarek K
TK
Rajji
b Department of Psychiatry , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.|e Campbell Family Mental Health Research Institute , Centre for Addiction and Mental Health , Toronto , ON , Canada.
Benoit H
BH
Mulsant
D000928:Antidepressive Agents / Q000627:therapeutic use*; D003521:Cyclopropanes / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D000078764:Milnacipran; D010879:Piperazines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013440:Sulfides / Q000627:therapeutic use; D000069503:Vilazodone Hydrochloride / Q000627:therapeutic use; D000078784:Vortioxetine
D000928:Antidepressive Agents; D003521:Cyclopropanes; D010879:Piperazines; D013440:Sulfides; D000078784:Vortioxetine; D000078764:Milnacipran; D000069503:Vilazodone Hydrochloride
Aging; antidepressant; aripiprazole; clinical trials; depression; pharmacotherapy; quetiapine; review; vortioxetine