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Nortriptyline in the hospitalized elderly: tolerance and side effect reduction
J Rosen1, R Sweet, B G Pollock
1Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213.
Psychopharmacology Bulletin
|January 1, 1993
Summary
Nortriptyline (NT) is generally well-tolerated in elderly patients with late-life depression. Bethanechol effectively reduces the antimuscarinic side effects associated with NT treatment in this population.
Area of Science:
- Geriatric Psychiatry
- Clinical Pharmacology
Background:
- Late-life depression presents unique treatment challenges, including medication tolerance and side effect management.
- Nortriptyline (NT), a tricyclic antidepressant, is often used but can cause antimuscarinic side effects.
Purpose of the Study:
- To assess the tolerance of nortriptyline (NT) in elderly inpatients with late-life depression.
- To evaluate the efficacy of bethanechol in mitigating antimuscarinic side effects of NT.
Main Methods:
- Study 1: Assessed medication tolerance to NT in 72 elderly depressed inpatients.
- Study 2: A double-blind, placebo-controlled trial involving 26 elderly depressed patients treated with NT and receiving either bethanechol or placebo.
Main Results:
- Of 55 patients who started NT, only 9% discontinued due to side effects.
- Patients receiving bethanechol reported fewer subjective complaints of anticholinergic side effects.
- Bethanechol administration led to improved objective measures of salivary flow.
Conclusions:
- Nortriptyline (NT) demonstrates good tolerance in the acute treatment of late-life depression.
- Bethanechol is effective in reducing subjective and objective antimuscarinic side effects of NT in elderly patients.