Skip to main content
SpringerLink
Log in

Selective Serotonin Reuptake Inhibitors in Older Patients

A Tolerability Perspective

  • Review Article
  • Adverse Effects
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Summary

Depression is a serious illness that is common in the elderly but which is frequently overlooked. Management is complicated by physiological changes associated with aging, the presence of comorbid physical illness, and compliance problems; these factors must be taken into account when selecting an appropriate antidepressant. The well known problems associated with the tricyclic antidepressants (TCAs) [i.e. their unwanted anticholinergic, adrenergic and histaminergic effects], which are troublesome in younger patients, can have serious consequences for elderly depressed patients. The TCAs can cause symptoms that worsen concomitant physical illness, which is frequently present in the elderly, and their cardiotoxicity in overdose is of concern in both younger and older patients. The selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors have been shown to be as efficacious as the TCAs in the general depressed population, but to lack the anticholinergic adverse effects and cardiotoxicity associated with those drugs. Their increased safety and tolerability makes them a preferred treatment for depressed elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Blazer D. The diagnosis of depression in the elderly. J Am Geriatr Soc 1980; 28: 52–8

    PubMed  CAS  Google Scholar 

  2. Lindesay J, Briggs K, Murphy E. The Guy’s/Age Concern survey: prevalence rates of cognitive impairment, depression and anxiety in an urban elderly community. Br J Psychiatry 1989; 155: 317–29

    PubMed  CAS  Google Scholar 

  3. Gurland B, Copeland J, Kurlansky J, et al. The mind and mood of ageing. London/New York: Croom Helm, 1983

    Google Scholar 

  4. Murphy E. The prognosis of depression in old age. Br J Psychiatry 1983; 141: 111–9

    Article  Google Scholar 

  5. Conwell Y, Brent D. Suicide and ageing: I. Patterns of psychiatric diagnosis. Int Psychogeriatr 1995; 7: 149–64

    Article  PubMed  CAS  Google Scholar 

  6. Fiebel JH, Springer CJ. Depression and failure to resume social activities after stroke. Arch Phys Med Rehabil 1982; 63: 276–8

    Google Scholar 

  7. Silverstone PH. Depression increases mortality and morbidity in acute life-threatening medical illness. J Psychosom Res 1990; 34: 651–7

    Article  PubMed  CAS  Google Scholar 

  8. Bayer AJ, Pathy MS. Identification of depression in geriatric medical patients. In: Ghose K, editor. Antidepressants for elderly people. London: Chapman and Hall, 1989: 13–25

    Google Scholar 

  9. Montgomery SA. Treatment of depression in old age. In: Wheatley D, editor. Psychopharmacology of old age. Oxford: Oxford University Press, 1982: 165–72

    Google Scholar 

  10. Georgotas A, McCue RE, Cooper TB, et al. Factors affecting the delay of antidepressant effect in responders to nortriptyline and phenelzine. Psychiatry Res 1989; 28: 1–9

    Article  PubMed  CAS  Google Scholar 

  11. Cole MG. The prognosis of depression in the elderly. Can Med Assoc J 1990; 142: 633–9

    Google Scholar 

  12. Baldwin RC, Jolley DJ. The prognosis of depression in old age. Br J Psychiatry 1986; 149: 574–83

    Article  PubMed  CAS  Google Scholar 

  13. Montgomery SA, Lack SJ. Pharmacokinetic principles in the treatment of depression in the elderly. In: Stefanis CN, Rabavilas AD, Soldatos CR, editors. Psychiatry: a world perspective. Amsterdam: Elsevier, 1990: 40–5

    Google Scholar 

  14. Johnson DAW. Depression: treatment compliance in general practice. Acta Psychiatr Scand 1981; 63 Suppl. 290: 447–53

    Article  Google Scholar 

  15. Moskowitz H, Burns MM. Cognitive performance in geriatric subjects after acute treatment with antidepressants. Neuropsychobiology 1986; 15 Suppl. 1: 38–43

    Article  PubMed  Google Scholar 

  16. Nolan L, O’Malley K. Adverse effects of antidepressants in the elderly. Drugs Aging 1992; 2: 450–8

    Article  PubMed  CAS  Google Scholar 

  17. Ray WA. Psychotropic drugs and injuries among the elderly: a review. J Clin Psychopharmacol 1992; 12: 386–96

    PubMed  CAS  Google Scholar 

  18. Campbell AJ. Drug treatment as a cause of falls in old age: a review of offending agents. Drugs Aging 1991; 1: 289–302

    Article  PubMed  CAS  Google Scholar 

  19. Salzman C. Pharmacologic treatment of depression in the elderly. J Clin Psychiatry 1993; 54 Suppl. 2: 23–8

    PubMed  Google Scholar 

  20. Montgomery SA. New psychotropic drugs for the acute treatment of depressive episodes. In: Costa E, Silva JA, Nadelson CC, editors. International review of psychiatry. Washington, DC: American Psychiatric Press, 1993: 139–60

    Google Scholar 

  21. Andersen J, Bech P, Benjaminsen S, et al. Citalopram: clinical efficacy profile in comparison with clomipramine. A controlled multicentre study. Psychopharmacology 1986; 90: 131–8

    Google Scholar 

  22. Danish University Antidepressant Group. Paroxetine: a selective serotonin reuptake inhibitor showing better tolerability but weaker antidepressant effect than clomipramine in a controlled multicentre study. J Affect Disord 1990; 18: 289–99

    Article  Google Scholar 

  23. Anderson IM, Tomensen BM. Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis. BMJ 1995; 310: 1433–8

    Article  PubMed  CAS  Google Scholar 

  24. Montgomery SA, Henry J, Mcdonald G, et al. Selective serotonin reuptake inhibitors: metaanalysis of discontinuation rates. Int Clin Psychopharmacol 1994; 9: 47–53

    Article  PubMed  CAS  Google Scholar 

  25. Katona CLE. Treating depression in older people. In: Feighner JP, Boyer WF, editors. Selective serotonin re-uptake inhibitors: advances in basic research and clinical practice. Chichester: John Wiley, 1996: 179–204

    Google Scholar 

  26. Wakelin JS. Fluvoxamine in the treatment of the older depressed patient: double blind placebo controlled data. Int Clin Psychopharmacol 1986; 1: 221–30

    Article  PubMed  CAS  Google Scholar 

  27. Rahman MK, Akhtar MJ, Savla NC, et al. A double-blind, randomised comparison of fluvoxamine with dothiepin in the treatment of depression in elderly patients. Br J Clin Pract 1991; 45: 255–8

    PubMed  CAS  Google Scholar 

  28. Phanjoo AL, Wonnacott S, Hodgson A. Double-blind comparative multicentre study of fluvoxamine and mianserin in the treatment of major depressive episode in elderly people. Acta Psychiatr Scand 1991; 83: 476–9

    Article  PubMed  CAS  Google Scholar 

  29. Tollefson GD, Holman SJL. Analysis of the Hamilton Depression Rating Scale factors from a double-blind, placebo-controlled trial of fluoxetine in geriatric major depression. Int Clin Psychopharmacol 1993; 8: 253–9

    Article  PubMed  CAS  Google Scholar 

  30. Feighner JP, Cohn JB. Double-blind comparative trials of fluoxetine and doxepin in geriatric patients with major depressive disorder. J Clin Psychiatry 1985; 46: 20–5

    PubMed  CAS  Google Scholar 

  31. Altamura AC, Percudani M, Guercetti G, et al. Efficacy and tolerability of fluoxetine in the elderly: a double-blind study versus amitriptyline. Int Clin Psychopharmacol 1989; 4: 103–6

    PubMed  Google Scholar 

  32. Falk WE, Rosenbaum JE, Otto MW, et al. Fluoxetine versus trazodone in depressed geriatric patients. J Geriatr Psychiatry Neurol 1989; 2: 208–14

    Article  PubMed  CAS  Google Scholar 

  33. Dunner DL, Cohn JB, Walshe T, et al. Two combined multicentre double-blind studies of paroxetine and doxepin in geriatric patients with major depression. J Clin Psychiatry 1992; 53: 57–60

    PubMed  Google Scholar 

  34. Guillibert E, Pelicier Y, Archambault JL, et al. A double-blind, multi-centre study of paroxetine v clomipramine in depressed elderly patients. Acta Psychiatr Scand 1989; 80 Suppl. 350: 132–4

    Article  Google Scholar 

  35. Hutchinson DR, Tong S, Moon CAL, et al. A double-blind study in general practice to compare the efficacy and tolerability of paroxetine and amitriptyline in depressed elderly patients. Br J Clin Res 1991; 2: 43–7

    Google Scholar 

  36. Dorman T. Sleep and paroxetine: a comparison with mianserin in elderly depressed patients. J Clin Psychiatry 1992; 53 Suppl.: 53–8

    Google Scholar 

  37. Schone W, Ludwig M. A double-blind study of paroxetine compared with fluoxetine in geriatric patients with major depression. J Clin Psychopharmacol 1993; 13 Suppl. 2: 34–9

    Google Scholar 

  38. Dunbar GC. Paroxetine in the elderly: a comparative meta-analysis against standard antidepressant pharmacotherapy. Pharmacology 1995; 51: 127–44

    Article  Google Scholar 

  39. Cohn CK, Shrivastava R, Mendel SJ, et al. Double blind multicentre comparison of sertraline and amitriptyline in elderly depressed patients. J Clin Psychiatry 1990; 51 Suppl. 8: 28–33

    PubMed  Google Scholar 

  40. Nyth AL, Gottfries CG. The clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders: a Nordic multicentre study. Br J Psychiatry 1990; 157: 894–901

    Article  PubMed  CAS  Google Scholar 

  41. Nyth A, Gottfries CG, Lyby K, et al. A controlled multicenter clinical study of citalopram and placebo in elderly depressed patients with and without concomitant dementia. Acta Psychiatr Scand 1989; 86: 138–45

    Article  Google Scholar 

  42. Montgomery SA. The efficacy of fluoxetine as an antidepressant in the short and long term. Int Clin Psychopharmacol 1989; 4 Suppl. 1: 113–9

    PubMed  Google Scholar 

  43. Kerr JS, Sherwood N, Hindmarch I. The comparative psychopharmacology of 5-HT re-uptake inhibitors. Hum Psychopharm 1991; 6: 313–7

    Article  CAS  Google Scholar 

  44. Price J, Waller P, Wood S, et al. Safety of fluoxetine: comparison with fluvoxamine. Pharmacoepidemiol Drug Saf 1992; 1: 111–7

    Article  Google Scholar 

  45. Wagner W, Plekkenpol B, Gray TE, et al. Review of fluvoxamine safety database. Drugs 1992; 43 Suppl. 2: 48–54

    Article  PubMed  Google Scholar 

  46. Wakelin JS. The role of serotonin in depression and suicide: do serotonin reuptake inhibitors provide a key? Adv Biol Psychiatry 1988; 17: 70–83

    Google Scholar 

  47. Montgomery SA. The advantages of paroxetine in different subgroups of depression. Int Clin Psychopharmacol 1992; 6 Suppl. 4: 91–100

    Article  PubMed  Google Scholar 

  48. Herman JB, Brotman AW, Pollack MH, et al. Fluoxetine-induced sexual dysfunction. J Clin Psychiatry 1990; 51: 25–7

    PubMed  CAS  Google Scholar 

  49. Cooper GL. The safety of fluoxetine: an update. Br J Psychiatry 1988; 153 Suppl. 3: 77–86

    Google Scholar 

  50. Hindmarch I. Antidepressants: the implications of the cognitive and psychomotor effects in the elderly. Int Clin Psychopharmacol 1990; 5 Suppl. 3: 57–60

    PubMed  Google Scholar 

  51. Moro F, Scapagnini U, Scaletta S, et al. Serotonin nerve endings and regulation of pupillary diameter. Ann Ophthalmol 1981; 13: 487–90

    PubMed  CAS  Google Scholar 

  52. Roose SP, Glassman AH, Giardina EG, et al. Tricyclic antidepressants in depressed patients with cardiac conduction disease. Arch Gen Psychiatry 1987; 44: 273–5

    Article  PubMed  CAS  Google Scholar 

  53. Amin MM, Ananth JV, Coleman BS, et al. Fluvoxamine: antidepressant effect confirmed in a placebo-controlled international study. Clin Neuropharmacol 1984; 7 Suppl. 1: 317–8

    Article  Google Scholar 

  54. Guy S, Silke B. The electrocardiogram as a tool for therapeutic monitoring: a critical analysis. J Clin Psychiatry 1990; 51 Suppl. 8: 37–9

    PubMed  Google Scholar 

  55. Evans ME, Lye M. Depression in the elderly physically ill: an age study of treatment with the 5HT reuptake inhibitor fluoxetine. J Clin Exp Gerontol 1992; 14: 297–307

    Google Scholar 

  56. Fisch C. Effect of fluoxetine on the electrocardiogram. J Clin Psychiatry 1985; 46 Suppl. 3: 42–4

    PubMed  CAS  Google Scholar 

  57. Ellison JM, Milofsky JE, Ely E. Fluoxetine induced bradycardia and syncope in two patients. J Clin Psychiatry 1990; 51: 385–6

    PubMed  CAS  Google Scholar 

  58. Buff D, Brenner R, Kirtane SS, et al. Dysthymia associated with fluoxetine treatment in an elderly patient with cardiac disease. J Clin Psychiat 1991; 52: 174–6

    CAS  Google Scholar 

  59. Spier SA, Frontera MA. Unexpected deaths in depressed medical inpatients treated with fluoxetine. J Clin Psychiatry 1991; 52: 377–82

    PubMed  CAS  Google Scholar 

  60. Henry JA, Alexander CA, Sener EK. Relative mortality from overdose of antidepressants. BMJ 1995; 310: 221–4

    Article  PubMed  CAS  Google Scholar 

  61. Montgomery SA, Dunner DL, Dunbar GC. Reduction of suicidal thoughts with paroxetine in comparison with reference anti-depressants and placebo. Eur Neuropsychopharmacol 1995; 5: 5–13

    Article  PubMed  CAS  Google Scholar 

  62. Song F, Freemantle N, Sheldon TA, et al. Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. BMJ 1993; 306: 683–7

    Article  PubMed  CAS  Google Scholar 

  63. Hebenstreit FG, Feilerer K, Zochling R, et al. A pharmacokinetic dose titration study in adult and elderly depressed patients. Acta Psychiatr Scand 1989; 80 Suppl. 350: 81–4

    Article  Google Scholar 

  64. Montgomery SA, Pedersen V, Tangjhoj P, et al. The optimal dosing regime for citalopram: a meta-analysis of nine placebo-controlled studies. Int Clin Psychopharmacol 1994; 9 Suppl. 1: 35–40

    Article  PubMed  Google Scholar 

  65. Jenner PB. Paroxetine: an overview of dosage, tolerability, and safety. Int Clin Psychopharmacol 1992; 6 Suppl. 4: 69–80

    Article  PubMed  Google Scholar 

  66. Fredericson-Overo K, Toft B, Christopherson L, et al. Kinetics of citalopram in elderly patients. Psychopharmacology (Berl) 1985; 86: 253–7

    Article  CAS  Google Scholar 

  67. Lemberger L, Bergstrom RF, Wolen RL, et al. Fluoxetine: clinical pharmacology and physiologic disposition. J Clin Psychiatry 1985; 46: 14–9

    PubMed  CAS  Google Scholar 

  68. Murdoch D, McTavish D. Sertraline: a review of its pharmacodynamic and pharmacokinetic properties, therapeutic potential in depressive illness, and prospective role in the treatment of obsessive-compulsive disorder. Drugs 1992; 44: 604–24

    Article  PubMed  CAS  Google Scholar 

  69. Benfield P, Ward A. Fluvoxamine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs 1986; 32: 313–34

    Article  PubMed  CAS  Google Scholar 

  70. Schenker S, Bergstrom RF, Wolen RL, et al. Fluoxetine disposition and elimination in cirrhosis. Clin Pharmacol Ther 1988; 44: 353–9

    Article  PubMed  CAS  Google Scholar 

  71. Baumann P. Clinical pharmacokinetics of citalopram and other selective serotonergic reuptake inhibitors. Int Clin Psychopharmacol 1992; 6 Suppl. 5: 13–20

    Article  PubMed  Google Scholar 

  72. Beasley CM, Masica DN, Heiligenstein JH, et al. Possible monoamine oxidase inhibitor serotonin uptake inhibitor interaction: fluoxetine clinical data and preclinical findings. J Clin Psychopharmacol 1993; 13: 312–20

    Article  PubMed  Google Scholar 

  73. Graber MA, Hoehns TB, Perry PJ. Sertraline-phenelzine drug interaction: a serotonin syndrome reaction. Ann Pharmacother 1994; 28: 732–5

    PubMed  CAS  Google Scholar 

  74. Committee on Safety of Medicines. Antidepressant-induced hyponatraemia. Curr Prob Pharmacovigilance 1994; 20: 5–6

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Imperial College of Science Technology, St Mary’s Hospital Medical School, London, England

    Ursula Skerritt, Richard Evans &  Stuart A. Montgomery

Authors
  1. Ursula Skerritt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stuart A. Montgomery
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Skerritt, U., Evans, R. & Montgomery, S.A. Selective Serotonin Reuptake Inhibitors in Older Patients. Drugs & Aging 10, 209–218 (1997). https://doi.org/10.2165/00002512-199710030-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199710030-00005

Keywords

Search

Navigation