Which antidepressant?

Antidepressants in the Elderly

“…In patients with a past history of depression, their previous response to treatment is a valuable guide to the most appropriate drug to use for the current episode. 69 Otherwise, while there are not enough data to suggest a preference for any particular drug based on absolute therapeutic efficacy, the one area of major concern in the choice of antidepressant in the elderly is side-effects. Of particular importance are the number of falls and fractures in the elderly associated with OH 11 and anticholinergic effects which can lead to confusion and urine retention.…”

“…For patients at the younger end of the psychogeriatric age range in whom there are no complicating factors such as physical illness or potential interactions with other medication, TCAs or other antidepressants can be used, depending on the clinician's preference. Indeed, many clinicians might still choose one of the standard TCAs such as imipramine or amitriptyline, because these drugs have been well studied and physicians are familiar with them 69 …”

“…Indeed, many clinicians might still choose one of the standard TCAs such as imipramine or amitriptyline, because these drugs have been well studied and physicians are familiar with them. 69 For the old old (above 75 years), the frail elderly or those with significant medical illness, amitriptyline and imipramine should be avoided. The secondary amine TCAs, lofepramine, the SSRis and other newer antidepressants are useful alternatives.…”