Selective Serotonin Reuptake Inhibitors for Late-Life Depression
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Drugs & Aging 2001; 18 (5): 355-368 1170-229X/01/0005-0355/$22.00/0 © Adis International Limited. All rights reserved.
Selective Serotonin Reuptake Inhibitors for Late-Life Depression A Comparative Review LalithKumar K. Solai,1 Benoit H. Mulsant2 and Bruce G. Pollock3 1 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA 2 University of Pittsburgh School of Medicine and Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA 3 Psychopharmacology and Pharmaceutical Sciences, University of Pittsburgh School of Medicine and Geriatric Psychopharmacology Program, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Contents Abstract . . . . . . . . . . . . . . . . . . . 1. Efficacy . . . . . . . . . . . . . . . . . . . 2. Safety and Tolerability . . . . . . . . . . . . 2.1 Elderly Patients with Concurrent Illness 3. Drug-Drug Interactions . . . . . . . . . . . 4. Pharmacokinetic Considerations . . . . . 5. Conclusion . . . . . . . . . . . . . . . . . .
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Late-life depression is a serious health problem that is challenging to manage but generally responds well to pharmacotherapy. Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs), the most commonly prescribed antidepressants, are usually used as first-line agents for elderly patients with depression. Like most drugs, SSRIs have not been widely tested in clinical trials that approximate ‘real-life’ geriatric situations. However, studies completed to date provide valuable information about the efficacy, safety and tolerability of this class of antidepressants among older patients with depression, including those with depression secondary to stroke or dementia and those with other comorbid physical disorders. Although one SSRI may be more efficacious or better tolerated by elderly patients than another, existing data do not support such claims. However, other distinguishing features may influence the choice of agent. For example, fluoxetine, fluvoxamine and paroxetine are more likely to be involved in significant drug-drug interactions than are citalopram or sertraline. In contrast to the other SSRIs, fluoxetine has a half-life well in excess of 1 day, which can be an advantage when weaning the patient off therapy in that it may reduce the incidence of discontinuation symptoms, but a significant disadvantage if the patient cannot tolerate the drug or experiences an adverse drug-drug interaction.
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