Antidepressant pharmacotherapy in old-age depression—a review and clinical approach

Pruckner, Nathalie; Holthoff-Detto, Vjera

doi:10.1007/s00228-017-2219-1

Cited by 27 publications

(24 citation statements)

References 56 publications

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“…It is claimed that secondary amine tricyclics (e.g., nortriptyline, desipramine) are preferred to tertiary amine types (e.g., imipramine, amitriptyline) as these have milder side effects and a less complex metabolic profile [14]. Nortriptyline is the most extensively studied of the tricyclic antidepressants but like other tricyclics, anticholinergic side effects are prominent and there are issues related to cardiovascular toxicity, especially on overdose [19].…”

Section: Tricyclic Antidepressantsmentioning

confidence: 99%

Antidepressant Treatment of Depression in the Elderly: Efficacy and Safety Considerations

Norman¹

2021

obm neurobiol

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Depression in the elderly is a significant clinical problem which is likely to endure as an ongoing issue as the cohort of individuals aged over 65years continues to increase as a proportion of the total population. While there are a multiplicity of approaches to the treatment of depression, the mainstay for moderate to severe cases is pharmacotherapy. The majority of extant antidepressants have demonstrated efficacy, at least in short term (6-12weeks) clinical evaluations. There is demonstrable efficacy over and above that of placebo in the majority of clinical trials for most agents. Within the classes of antidepressants there is no difference between individual agents, while between classes differences have not been demonstrated consistently. Thus, there appears to be little to choose between the various agents. However, considerations other than efficacy play a role in the choice of an antidepressant for an individual patient. A systematic review of the efficacy of antidepressant agents based on trials in elderly populations is presented. Factors influencing the choice of a medication over and above efficacy are presented along with a brief review of adverse events of particular concern in elderly patients. A considerable proportion of elderly patients have comorbid medical conditions, which may also influence the choice of agent due to drug-drug interaction considerations. A brief overview of interactions likely to influence medication selection is also canvassed. While there is every reason to be optimistic about outcomes in elderly patients, there are still unanswered questions about antidepressant efficacy in this population: effectiveness in long-term treatment and in the population of so-called ‘old-old’ elderly are principal among them.

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Section: Tricyclic Antidepressantsmentioning

confidence: 99%

Antidepressant Treatment of Depression in the Elderly: Efficacy and Safety Considerations

Norman¹

2021

obm neurobiol

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“…Neben oben vorgestellten klinischen Studien wurden auch vier Reviews mit der Literaturrecherche gefunden [5,16,17,18]. In allen Reviews konnte die Wirksamkeit von Lithium als Augmentationsstrategie bei Altersdepression bestätigt werden.…”

Section: Lithiumaugmentation Bei Der Altersdepressionunclassified

“…Zusätzlich wurden in den einzelnen Reviews spezifische Empfehlungen hinsichtlich dieser Patientengruppe abgegeben: Pruckner und Holthoff-Detto raten in ihrem Review zu einer Serumkonzentration zwischen 0,5 mmol/l-0,6 mmol/l von Lithium im Blut bei den älteren Patienten. Zur Vermeidung von Intoxikationen aufgrund von Elektrolytverschiebungen durch Durchfall, Dehydratation und der Einnahme von Diuretika sollten regelmäßige Kontrollen der Nierenparameter bei der Langzeitanwendung erfolgen, auch zur Vermeidung eines Nierenversagens [16]. Abou-Saleh und Kollegen betonen ebenfalls die Effektivität des Lithiums in der Behandlung der unipolaren Depression und erinnern noch einmal daran, dass es als einziges Medikament einen nachgewiesenen anti-suizidalen Effekt hat [17].…”

Section: Lithiumaugmentation Bei Der Altersdepressionunclassified

„Lithium in der Behandlung der Altersdepression. Was spricht dafür, was dagegen?“

Stühler

Quante

2018

Fortschr Neurol Psychiatr

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Zusammenfassung Anliegen Die Lithiumaugmentation ist eine der Behandlungsoptionen bei therapieresistenter Depression. In diesem Review soll die Studienlage zu der Anwendung von Lithium im höheren Lebensalter bei unipolarer Depression zusammengefasst werden. Methode Es wurde eine selektive Literaturrecherche in PubMed durchgeführt. Es konnten insgesamt 15 relevante Artikel (Plazebokontrollierte Studien und Übersichtsarbeiten) miteinbezogen werden. Ergebnisse: Sowohl die klinischen Studien als auch die Reviews sprechen sich positiv für die Lithiumaugmentation im Alter aus. Die Remissionsraten und das Ansprechen auf das Lithium allgemein sind sehr hoch. Nierenschäden als gefürchtete Nebenwirkungen treten nur selten auf. Auch über längere Anwendung hinaus zeigt sich das Lithium als wirksam und verträglich, wobei Laborkontrollen engmaschiger durchgeführt werden sollten. Schlussfolgerung Lithium präsentiert sich als wirksames Medikament bei therapieresistenter unipolaren Altersdepression. Im klinischen Alltag ist der Einsatz bei fehlender Kontraindikation zu empfehlen.

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“…Depression affects patient’s ability to cope with the burden of the illness decreasing the acceptance of treatment, extending hospitalization, reducing quality of life and increasing suicide risk by 50% for men and 30% for women [ 6 ]. Effective treatments which may be offered for moderate and severe depression include behavioural activation, cognitive behavioural therapy (CBT), and interpersonal psychotherapy (IPT) [ 7, 8 ] or antidepressant medication such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review: Depression and Anxiety Prevalence in Bladder Cancer Patients

Vartolomei

Ferro

Mirone

et al. 2018

BLC

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Background:Depression affects more than 300 million people of all ages worldwide. In patients with cancer the reported prevalence is up to 24%.Objective:To systematically review the literature to report the prevalence of depression and anxiety among patients with bladder cancer (BC).Methods:Web of Science, MEDLINE/PubMed, and The Cochrane Library were searched between January and March 2018 using the terms “bladder carcinoma OR bladder cancer AND depression OR anxiety”.Results:Thirteen studies encompassing 1659 patients with BC were included. Six studies assessed depression prior and after treatment at 1, 6 and 12 months. Three were conducted in the US, one each in Turkey, Sweden/Egypt and China. Four studies showed a reduction of depression after radical cystectomy (RC) at 1, 6 and 12 months, respectively. Contrary, two studies showed no significant difference in depression between baseline and follow-up. Four studies investigated anxiety; they reported a slight reduction in anxiety score compared to baseline. Seven additional studies reported the prevalence of depression and anxiety (five studies) among patients with BC at a specific time-point. Studies were conducted in Sweden (2), Italy, Greece, US, China and Spain. Pretreatment depression rates ranged from 5.7 to 23.1% and post-treatment from 4.7 to 78%. Post-treatment anxiety rates ranged from 12.5 to 71.3%.Conclusions:The prevalence of reported depression and anxiety among BC patients is high with large geographic heterogeneity. Gender and geriatric specific screening and management for anxiety and depression should be implemented to alleviate suffering.

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Antidepressant pharmacotherapy in old-age depression—a review and clinical approach

Cited by 27 publications

References 56 publications

Antidepressant Treatment of Depression in the Elderly: Efficacy and Safety Considerations

Antidepressant Treatment of Depression in the Elderly: Efficacy and Safety Considerations

„Lithium in der Behandlung der Altersdepression. Was spricht dafür, was dagegen?“

Systematic Review: Depression and Anxiety Prevalence in Bladder Cancer Patients

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