When it comes to antidepressants for elderly patients, most experts recommend SSRIs or selective norepinephrine reuptake inhibitors (SNRIs), which help increase certain brain chemicals such as serotonin. These drugs tend to have fewer serious side effects and drug interactions than older antidepressants on the market.
Tricyclic antidepressants, especially amitriptyline and dothiepin,16 are known to pose a high risk of death in overdosage. These drugs should therefore be avoided in older people whose medication is not supervised and who are at risk of taking an overdose.
SSRIs considered to have the best safety profile in the elderly are citalopram, escitalopram, and sertraline. [16] These have the lowest potential for drug-drug interactions based on their cytochrome P-450 interactions.
Buspirone is an anti-anxiety drug that has been shown to be effective for older adults. Benzodiazepines, another anti-anxiety drug, are effective but should be prescribed carefully to older adults because of risk of memory impairment, unsteadiness, and falls.
Second-generation antidepressants (SSRIs, SNRIs or NDRIs) are recommended for older adults due to the reduced risk of side effects and safety in the event of overdose. If considering medication for older adults with depression, the panel recommends combining it with interpersonal psychotherapy.
Many doctors start by prescribing a type of drug called a selective serotonin reuptake inhibitor (SSRI), such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) or sertraline (Zoloft).
The first-line medicine for patients with depression is generally a SSRI, e.g. citalopram, escitalopram, sertraline or fluoxetine (Tables 1 and 2).
Benzodiazepines (also known as tranquilizers) are the most widely prescribed type of medication for anxiety. Drugs such as Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam) work quickly, typically bringing relief within 30 minutes to an hour.
Some common risk factors for anxiety disorders in seniors include: Stressful life events (e.g., death of a loved one) Limited physical mobility. Loss of independence.
Conclusion: Sertraline is an effective and well tolerated antidepressant for the treatment of major depressive disorder in patients aged > or =60 years.
In the study, Lenze and colleagues evaluated 177 people aged 60 or older with generalized anxiety disorder who got either Lexapro or a dummy pill for 12 weeks. They found 69 percent of patients got better, compared with 51 percent of those whose symptoms improved simply by taking a placebo.
Studies have found that while antidepressants can be helpful in older adults, they may not always be as effective as in younger patients. Also, the risk of side effects or potential reactions with other medicines must be carefully considered.
SSRIs are the most widely prescribed type of antidepressants. They're usually preferred over other antidepressants, as they cause fewer side effects. An overdose is also less likely to be serious. Fluoxetine is probably the best known SSRI (sold under the brand name Prozac).
Drugs Older Adults Should Use with Caution
Also, consider avoiding aspirin, ibuprofen, and naproxen entirely if you're older than 75, taking an oral steroid, or taking a prescription blood thinner. Heart failure or irregular heartbeat medication: digoxin (Lanoxin).
Overall, citalopram appears to be the best-tolerated SSRI, followed by fluoxetine, sertraline, paroxetine, and fluvoxamine. The latter 2 drugs are associated with the most side effects and the highest discontinuation rates because of side effects in clinical trials.
Anxiety becomes more common with older age and is most common among middle-aged adults. This may be due to a number of factors, including changes in the brain and nervous system as we age, and being more likely to experience stressful life events that can trigger anxiety.
Listen to music
Many caregivers find that, if it's meaningful to them, playing familiar spiritual music can have a calming effect on their aging loved ones. For another caregiver, her aging loved one calms to the sound of bagpipes, a familiar sound from childhood.
The selective serotonin reuptake inhibitors (SSRIs) are probably the treatment of choice in treating depression and a gamut of comorbid anxiety disorders. The most used SSRI is escitalopram.
Buspar® (Buspirone)
This non-addictive anxiety medication is similar to an SSRI in that it increases chemical messengers involving serotonin. Buspar only targets one subtype of the serotonin receptor, so it affects just one specific area of your brain.
The original “happy pill” was fluoxetine, more commonly known as Prozac. This medication, approved for use in 1987, was the first drug of its kind to be prescribed and marketed on a large scale. The use of this medication is very common, especially for the treatment of depression, but it is not without its risks.
Auvelity is an N-methyl D-aspartate (NMDA) receptor antagonist, marking the first new type of medication to be approved for clinical depression in 60 years.
Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors are considered second line due to tolerability and safety issues. Other adjunctive medications include atypical antipsychotics, lithium, adding a second antidepressant, buspirone, and thyroid hormone (T3) among others.
Carbamazepine. Rapid cycling and occurrence of irritable mania are features known to occur relatively more commonly in the elderly population. Carbamazepine is effective in managing both these symptoms (Greil et al., 1998, Weisler et al., 2005).