Clinical guidelines for the use of antidepressant drugs in geriatric patients

This paper reviews the diagnosis and treatment of geriatric patients. Careful distinction between true depression and dysphoria or normal sadness and thoughts of death among elderly patients must be made. The dexamethasone suppression test is useful in such a distinction in older patients, although its usefulness in younger adults is less certain. The aging process alters the pharmacokinetics of cyclic antidepressants. In particular, metabolism is delayed so that accumulation in the blood stream occurs, leading to prolonged elimination half-life. Side effect patterns of the cyclic antidepressants suggest that secondary amines are less toxic as a group than tertiary amines, and thus may be preferred as the treatments of first choice. Monoamine oxidase inhibitors are underutilized in the treatment of depressed older patients and should be considered, particularly when the depression includes symptoms of apathy and anergia. Special attention must be paid to the depressed elderly patient with cardiovascular disease or hypertension. Suggestions for treatment are provided.