Sertraline and mirtazapine as geriatric antidepressants

Depression within the geriatric patient population is an important issue as it is associated with increased mortality. Such depression may have a different aetiology to that in younger patients and be associated with comorbid chronic physical health problems or cognitive impairment. However, there is no specific UK guideline for the treatment of depression within elderly patients. The first-line pharmacological treatment recommended by the National Institute for Health and Care Excellence (NICE) is to use a serotonin-selective reuptake inhibitor (SSRI). Unfortunately these can have significant side-effects in the elderly such as hyponatraemia. Sertraline is one such SSRI commonly used in the geriatric population. Mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSa) is seeing increasing usage as an alternative agent. Here we evaluate the role of using the NaSSA in place of the SSRI and how such drugs may be cross-titrated.

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Limited evidence suggests that for certain elderly patients, mirtazapine may be preferable to sertraline for treatment of depression. It may also be more cost-effective in patients who have dementia. The choice is highly dependent upon individual co-morbidities and subsequent polypharmacy. If required, sertaline can be cross-titrated to mirtazapine.