Lofepramine in the elderly

Depression prevails in 12-13% of the elderly, of whom a 5th suffer major depressive illness. First admission-rates to psychiatric beds in England increase with aging until the 80s, when they fall off in women but continue to rise in men. Physical illness is a considerable contributor to depression in old age, and consequently depression is more prevalent in elderly general hospital inpatients than in the community. Better screening instruments are needed to detect this depression, and the place of antidepressant therapy needs to be better established. All antidepressants fall short of the ideal, particularly through acting slowly, having side-effects and being dangerous in overdose. Justifiably popular though dothiepin is in the treatment of depression in the elderly, its fatal toxicity index is high. Lofepramine appears to be as effective, to have fewer side-effects and to be safer, but experience of it is relatively meagre in the elderly and satisfactory double-blind comparisons with suitable control drugs in this age group have yet to be reported. If it lives up to its present promise it may be particularly suitable for the physically ill and depressed elderly.