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Clomipramine in the elderly: tolerance and plasma levels
M E Kunik1, B G Pollock, J M Perel
1Department of Psychiatry, University of Pittsburgh, School of Medicine, Pennsylvania.
Journal of Geriatric Psychiatry and Neurology
|July 1, 1994
Summary
Clomipramine effectively treated depression in elderly women at lower doses than typically used. This antidepressant was well-tolerated, significantly reducing depressive symptoms and somatic complaints in older patients.
Area of Science:
- Geriatric Psychiatry
- Clinical Pharmacology
Background:
- Treatment-resistant depression is a significant challenge in elderly populations.
- Limited data exists on clomipramine efficacy and dosing in older adults.
Purpose of the Study:
- To evaluate the safety and efficacy of clomipramine in elderly, treatment-resistant depressed female patients.
- To determine appropriate dosing and steady-state plasma levels for this demographic.
Main Methods:
- Five elderly female patients (67-80 years) with treatment-resistant depression received clomipramine.
- Plasma clomipramine levels were monitored to achieve a steady state.
- Depression and somatic complaints were assessed using validated rating scales.
Main Results:
- Elderly patients achieved therapeutic steady-state plasma levels at lower doses than reported for younger adults.
- Clomipramine was well-tolerated in this cohort.
- Significant reductions were observed: 42% decrease in depression (Hamilton Rating Scale) and 57% decrease in somatic complaints (Rating Scale for Side Effects).
Conclusions:
- Clomipramine may serve as an effective alternative treatment for elderly patients with treatment-resistant depression.
- Lower doses and therapeutic drug monitoring are recommended for safe and effective use in this age group.