Aging 2000: Our Health Care Destiny pp 349-357 | Cite as
Prospects for Safer Psychopharmacologic Treatment of Affective Disorders in the Elderly
Summary
With our present pharmaceutical and somatic modalities of intervention a very high percentage of elderly depressives may be effectively treated. Although a wide variety of side effects have been associated with the use of antidepressants such as TCAs, these may be minimized by (1) an understanding of the drug’s affinities for specific receptors; (2) a knowledge of the physiologic changes associated with normal and pathological aging which effect the pharmacokinetics of the TCA; (3) appropriate sampling of plasma levels; and (4) avoiding drug-drug interactions.
The future holds great promise for the development of new antidepressants that will be more specific and have a fewer side effects. As the specificity of antidepressants is increased, the greater will be the opportunities for understanding the biological underpinnings of depression in the elderly who so often challenge our diagnostic and clinical abilities.
Keywords
Unwanted Side Effect Anticholinergic Side Effect Biological Underpinning Fluphenazine Decanoate Adrenergic Receptor BlockerPreview
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References
- Asberg, M., Cronholm, B., Sjoquist, F., et al.: Relationship between plasma levels and therapeutic effect of nortriptyline. Br. Med. J. 3, 331–334 (1971).PubMedCrossRefGoogle Scholar
- Blackwell, B.: Antidepressant drugs: side effects and compliance. J. Clin. Psychiatry 43, 14–18 (1982).PubMedGoogle Scholar
- Blazer, D.: Depression in Late Life, 1st ed., Ch. 2. St. Louis: C.V. Mosby, 1982.Google Scholar
- Cassem, N.: Cardiovascular effects of antidepressants. J. Clin. Psychiatry 43, 22–28 (1982).PubMedGoogle Scholar
- Cole, J.: New antidepressant drugs. McLean Hospital Journal 8, 62–77 (1983a).Google Scholar
- Cole, J.O., Branconnier, R., Solomon, M., and Dessain, E.: Tricyclic use in the cognitively impaired elderly. J. Clin. Psychiatry 44, 14-19 (1983 b).Google Scholar
- Feighner, J.P.: Open label study of alprazolam in severely depressed inpatients. J. Clin. Psychiatry 44, 332–334 (1983).PubMedGoogle Scholar
- Friedel, R.O.: The relationship of therapeutic response to antidepressant plasma levels: An update. J. Clin. Psychiatry 43, 37–42 (1982).PubMedGoogle Scholar
- Hollister, L.E.: General principles of psychotherapeutic drug use in the aged. In Crook, T., and Cohen, G. (Eds.), Physician’s Handbook on Psychotherapeutic Drug Use in the Aged, 1st ed., Ch. 1, Mark Powley Associates, Inc. New Canaan, Conn.: 1981.Google Scholar
- Kragh-Sorensen, P., Hansen, C.E., Baastrup, P.C., et al.: Self-inhibiting action of nortriptyline’s antidepressive effect at high plasma levels. Psychopharmacologia 42, 305–312 (1976).CrossRefGoogle Scholar
- Miller, P.I., Beaumont, G., Seldrup, J., etal.: Efficacy, side effects, plasma and blood levels of maprotiline. J. Int. Med. Res. 5(Suppl. 4), 101–111 (1977).PubMedGoogle Scholar
- Nies, A., Robinson, D.S., Friedman, M.J., Green, R., et al.: Relationship between age and tricyclic antidepressant plasma levels. Am. J. Psychiatry 134, 790–793 (1977).PubMedGoogle Scholar
- Richelson, E.: Pharmacology of antidepressants in use in the United States. J. Clin. Psychiatry 43, 4–13 (1982).PubMedGoogle Scholar
- Richelson, E.: Are receptor studies useful for clinical practice? J. Clin. Psychiatry 44, 4–9 (1983).PubMedGoogle Scholar
- Siris, S.G., Cooper, T.B., Rifkin, A.E., et al.: Plasma imipramine concentrations in patients receiving concomitant fluphenazine decanoate. Am. J. Psychiatry 139, 104–106 (1982).PubMedGoogle Scholar
- Thayssen, P., Bjerre, M., Kragh-Sorensen, P., etal.: Cardiovascular effects of imipramine and nortriptyline in elderly patients. Psychopharmacology 74, 360–364 (1981).PubMedCrossRefGoogle Scholar
- Young, R.C., Manley, M.W., Shamoian, C.A., and Kutt, H.: Therapeutic Response to Nortriptyline in the Elderly. Proceedings of American Psychiatric Association, 135th Annual Meeting, Toronto, 1982, p. 210. Washington, D.C.: APA, 1982.Google Scholar
- Young, R.C., Alexopoulos, G.S., Manley, M.W., Shamoian, C.A., et al.: Plasma 10- hydroxynortriptyline in elderly depressives. CI. Pharm. Ther. 35, 540–544 (1984a)CrossRefGoogle Scholar
- Young, R.C., Alexopoulos, G.S., Shamoian, C.A., et al.: Heart failure and plasma 10-hydroxynortriptyline. Am. J. Psychiatry 141, 3 (1984b).Google Scholar