Zimeldine in the treatment of depression in the elderly

Epidemiological data indicate that the incidence of classical melancholia is lower among the elderly; however, light, atypical or secondary depressions appear to become more common during old age. Biochemical changes that occur with age or in association with dementia, may increase vulnerability to affective disorders. Preliminary studies show that zimeldine is an effective antidepressant with low cardiotoxicity and few anticholinergic side-effects, and it appears that the drug is well tolerated by the elderly. Drug regimens need to be carefully tailored to the elderly patient's requirements, however, as first-pass metabolism is reduced in some patients. An objective test to differentiate dementia from depression would be extremely valuable. Unfortunately, no such test has yet been found. The dexamethasone suppression test, for example, has proved to be unreliable in this context.