Antidepressants for Elderly People

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Depression is one of the commonest problems in old age. Yet until recently, old people were systematically exduded from participating in drug trials and similar investigations. As a result, knowledge regarding incidence, natural history and management of depression in the elderly are somewhat limited. It is now well-established that old people are sensitive to most psychotropic drugs and they tend to suffer from adverse effects and side effects of antidepressant drugs more frequently than any other age group. These are considered to be due to age-related physiological changes. In addition, because of the frequent association with multiple pathology, the elderly are likely to receive polypharmacy which further complicates the management of antidepressant drug therapy. The aim of this book is to provide a comprehensive guidance on the drug therapy of depression for the dinicians involved in the health care of the elderly. In the first section, epidemiology, presentations and assessment of depression in old age and neuroendocrine abnormalities observed in patients with depression are briefly discussed. However, it mainly deals with the problems of antidepressant drug therapy, such as which antidepressant to prescribe, how to monitor efficacy and side effects, what is the adequate dose, how long to treat a single episode of depression and who requires long term medication. Information regarding pharmacology, side effects, adverse effects, drug interaction and pharmacokinetics of most currently available drugs are provided. Special emphasis has been given on continuation therapy and the choice of an antidepressant drug and their long term safety.