Treatment for Geriatric Depression.ppt

Treatment for Geriatric Depression All classes have proven efficacy in elderly patients Yet, some evidence exists that antidepressants are less helpful in those over 75 Likely due to the difficulty in general treating depression in the elderly Role of cerebral vascular disease a factor 8 to 12 weeks in younger adults may stretch to 12-16 weeks in the elderly More concern with adverse events More possible medications to interact with Slower metabolism, excretion How to Choose an Antidepressant Approach to the patient Fatigue, insomnia, poor appetite Pain, HTN, heart disease, renal disease, liver disease, diabetes Anxiety, psychosis, cognition Approach to the drug How metabolized CYP450 system and drug interactions Fatigue ? of patients with depression report fatigue Serotonin-mediated countered by adrenergic, dopaminergic agents Effexor (venlafaxine), Cymbalta (duloxetine), Zoloft (sertraline), Prozac (fluoxetine) Augmentation agents Ritalin (methylphenidate), Provigil (modafinil) Cognitive behavioral therapy, exercise Make sure it is depression OSA common and looks like depression Especially if fatigue is the last resistant symptom Insomnia Common symptom in depression Serotonin 5HT2-mediated If activated insomnia occurs SSRIs, SNRIs If blocked sleepiness occurs Remeron (mirtazapine) Other agents Ambien (zolpidem) and Sonata (zaleplon) Lunesta (eszopiclone) Rozerem (ramelteon); M1, M2 receptor Sleep journal, sleep hygiene, avoid naps Make sure it is depression Not a primary sleep disorder, medications, caffeine, exercise Weight loss, poor appetite Common symptom of depression Many antidepressants cause weight gain We often look drug-induced weight gain as serendipity rather than an adverse event Remeron (mirtazapine) Like sleep, this effect lost when dose is increased above 30mg/d; comes as a dissolvable tablet for dysphagia Nortriptyline Histaminergic properties SSRIs Paxil (paroxetine)-most robust weight gaining SSRI Prozac (fluoxetine) and Zoloft (sertraline)-