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Antidepressants - Miscellaneous

nursing clinical depression journal life psychiatry

There are other antidepressants that do not belong to the previous categories mentioned and are grouped together here.

There is some data showing that the antidepressant buproprion is effective in late-life depression. It is thought to work by increasing the amount of dopamine available to the brain nerve cells and hence may be an attractive alternative medication. It has few interactions with other medications and fewer sexual side effects compared to the SSRIs but there is some concern for seizures at higher doses.

Nefazodone works somewhat like the SSRIs, but also has some other specific pathways through which it acts. Limited information is available at this time about the effectiveness of this medication in late-life depression. It can cause some very serious drug interactions.

Venlafaxine works by increasing both norepinephrine and serotonin, as do the TCAs. However, it is much more selective than the TCAs in affecting other nerve systems, which contribute to side effects. Nonetheless increases in blood pressure and nausea may be significant problems for some patients when using this medication.

Mirtazapine works at multiple sites in the brain to induce its antidepressant effect. There is information that it may help older patients, particularly those at risk of significant weight loss. Mirtazapine does increase appetite and also causes sedation, which may actually be helpful for some older people.

Methylphenidate is not considered an antidepressant but is sometimes used for older depressed people who are significantly withdrawn and lack motivation. Therefore it may be particularly useful in older depressed people undergoing rehabilitation. Limited data is available for its effect in depression.

St. John's Wort, a popular herbal remedy for mild to moderate depression, has not yet been thoroughly evaluated in older adults. However, St. John's Wort has recently been found to cause important drug interactions for many medications commonly used in the elderly, such as digoxin.

LALITHKUMAR K. SOLAI BRUCE G. POLLOCK

BIBLIOGRAPHY

DUNNER, D. L. "Therapeutic Consideration in Treating Depression in the Elderly." Journal of Clinical Psychiatry 55 (1994): 48–57.

GEORGOTAS, A.; MCCUE, R. E.; HAPWORTH, W.; FRIEDMAN, E.; KIM, M.; WELKOWITZ, J.; CHANG, I.; and COOPER, T. B. "Comparative Efficacy and Safety of MAOIs Versus TCAs in Treating Depression in the Elderly." Biological Psychiatry 21 (1986): 1155–1166.

GLASSMAN, A. H., and ROOSE, S. P. "Risks of Antidepressants in the Elderly: Tricyclic Antidepressants and Arrhythmia-Revising Risks." Gerontology 40 (1994): 15–20.

LEBOWITZ, B. D.; PEARSON, J. L.; SCHNEIDER, L. S.; REYNOLDSIII, C. F.; ALEXOPOULOS, G. S.; BRUCE, M. L.; CONWELL, Y.; KATZ, I. R.; MEYERS, B. S.; MORRISON, M. F.; MOSSEY, J.; NIEDEREHE, G.; and PARMELEE, P. "Diagnosis and Treatment of Depression in Late Life: Consensus Statement Update." Journal of the American Medical Association 278 (1997): 1186–1190.

LEO, R. J. "Movement Disorders Associated with the Serotonin Selective Reuptake Inhibitors." Journal of Clinical Psychiatry 57 (1996): 449–454.

NEWHOUSE, P. A. "Use of Selective Serotonin Reuptake Inhibitors in Geriatric Depression." Journal of Clinical Psychiatry 57 (1996): 12–22.

REYNOLDSIII, C. F.; FRANK, E.; PEREL, J. M.; MAZUMDAR, S.; and KUPFER, D. J. "Maintenance Therapies for Late-Life Recurrent Major Depression: Research and Review Circa." International Psychogeriatrics 7 (1995): 27–39.

RICHELSON, E. "Synaptic Effects of Antidepressants." Journal of Clinical Psychopharmacology 16 (1996): 1–9.

SCHNEIDER, L. S. "Pharmacological Considerations in the Treatment of Late-Life Depression." American Journal of Geriatric Psychiatry 4 (1996): 51–65.

SOLAI, L. K.; MULSANT, B. H.; and POLLOCK, B. G. "Update on the Treatment of Late-Life Depression." In The Psychiatric Clinics of North America—Annual of Drug Therapy. Edited by David L. Dunner and J. F. Rosenbaum. Philadelphia: W. B. Saunders Co., 1999: Pages 73–92.

THAPA, P. B.; GIDEON, P.; COST, T. W.; MILAM, A. B.; and RAY, W. A. "Antidepressants and the Risk of Falls among Nursing Home Residents." New England Journal of Medicine 339 (1998): 875–882.

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