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Related Experiment Videos

Hydroxydesipramine in the elderly.

J C Nelson1, E Atillasoy, C Mazure

  • 1Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510.

Journal of Clinical Psychopharmacology
|December 1, 1988
PubMed
Summary
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Elderly patients treated with desipramine (DMI) showed higher average plasma levels of its hydroxy metabolite (OH-DMI). While the increase was significant overall, its clinical importance in older adults requires further investigation.

Area of Science:

  • Pharmacology
  • Geriatric Medicine
  • Clinical Chemistry

Background:

  • Tricyclic antidepressants (TCAs) like desipramine (DMI) are used to treat depression.
  • Previous studies suggest elevated hydroxy metabolites of TCAs in elderly patients.
  • Hydroxydesipramine (OH-DMI) plasma levels were previously noted as elevated in a small group of older patients.

Purpose of the Study:

  • To investigate elevated hydroxydesipramine (OH-DMI) plasma levels in larger samples of depressed elderly patients.
  • To quantify the magnitude of OH-DMI increase in older adults compared to younger patients.
  • To explore the relationship between age, DMI dosage, and OH-DMI levels.

Main Methods:

  • Two patient samples were analyzed, with age groups defined as over 60 and younger.

Related Experiment Videos

  • Sample I used a fixed target dose of DMI, while Sample II adjusted DMI dose to a fixed blood level.
  • Plasma concentrations of DMI and its metabolite OH-DMI were measured and compared between age groups.

    • Main Results:

    • Combined analysis of both samples showed significantly higher average OH-DMI levels (11 ng/ml) in patients over 60.
    • OH-DMI concentrations were positively correlated with age when dosage variations were considered.
    • OH-DMI/DMI ratios were not significantly higher in older patients, but may increase at lower DMI doses.

    Conclusions:

    • Findings support prior reports of elevated hydroxy metabolite levels in elderly patients treated with desipramine.
    • The clinical significance of the observed 11 ng/ml increase in OH-DMI, relative to total DMI levels, is uncertain.
    • Age-related pharmacokinetic changes may influence desipramine metabolism in the elderly, warranting careful consideration in treatment.