Old Age - a Factor Influencing the Choice ofAntidepressant

Overview

Age represents an important factor influencing general principles of the pharmacotherapy andprophylaxis in late - life depression. Ageing may accentuate some clinical features and course ofdepression and may also increase the susceptibility to some side effects, e.g. extrapyramidal,cardiovascular or cognitive. Old patients and/or patients with serious physical disorders wereoften not included into clinical trials, so there are only limited data of EBM (Evidence BasedMedicine) category.We present a recent review concerning clinical manifestation and pharmacotherapy of late-lifedepression. Summary of published studies is illustrated by our clinical data. Summary of evidence:depression developed in old age has a more complex aetiology, weight loss, anxiety and poorsubjective memory or a dementia-like picture are common symptoms. Changes in cognitive orevent-related brain potential (P300) have been well established as a sensitive measure of cognitivedysfunction. It can be used to differentiate cognitive disturbances related to depression fromthose caused by organic brain disease. Safety and tolerability are most important parameters forthe choise of an antidepressant. Antidepressants with a selective mechanism of action are moresafe in the terms of treatment-related intensity and profile of side effects. Citalopram and sertralinehave well documented evidence of safety in the treatment of late - life depression with somaticcomorbidity. Antidepressants with dual effect, e.g. venlafaxine and mirtazapine may also haveeffectivity and tolerability advantages in this indication.

Key words:
depression. old age, antidepressants, safety of pharmacotherapy.