Antidepressants lor Elderly People

Antidepressants lor Elderly People

Antidepressants for Elderly People Edited by KARABI CHOSE Honorary Consultant in Geriatrie Medieine University o[ Wales College o[ Medicine S Springer-Science+Business Media, B.v.

1989 Springer Science+Business Media Dordrecht Originally published by Chapman and Hall Ltd in 1989. Softcover reprint ofthe hardcover 1st edition 1989 Typeset in 10/12 Palatino by Photoprint, Torquay, Devon ISBN 978-0-412-32460-4 ISBN 978-1-4899-3436-9 (ebook) DOI 10.1007/978-1-4899-3436-9 All rights reserved. No part of this book may be reprinted or reproduced, or utilized in any form or by any electronic, mechanical or other means, now known or hereafter invented, inc1uding photocopying and recording, or in any information storage and retrieval system, without permission in writing from the publisher. British Library Cataloguing in Publication Data Antidepressants for elderly people. 1. Antidepressant drugs I. Ghose, K. (Karabi), 1941-615'.78

Contents CONTRIBUTORS PREFACE Vll ix PART I THE NATURE AND PRESENTA non OF DEPRESSION 1 Presentation and assessment of depression in old age 3 Vimal K. Sharma and lohn R.M. Capeland 2 Identifieation of depression in geriatrie medical 13 patients, 3 Anthony J. Bayer and M.S. lohn Pathy The epidemiology and natural his tory of depression 27 in old age Cornelius L. E. Katona 4 Neuroendoerine abnormalities in depression and the 43 influenee of drugs fan McKeith PART 11 LITHIUM SALTS 5 Metabolie and endoerine effects of lithium 67 lohn H. Lazarus 6 Clinical pharmaeology of lithium salts 85 Karabi Ghose 7 Lithium in the prophylaxis of depressive illness in 103 late life Karabi Ghose and Alec Coppen PART III TRICYCLIC AND RELATED ANTIDEPRESSANTS 8 Pharmacokinetics of tricyclic and related 117 antidepressants Peter Crome and Sheila Dawling 9 Whieh antidepressant? 137 Maleolm Peet 10 Cardiovaseular effects of trieyclie antidepressants in 163 elderly people lila Dana-Haeri and Steve J. Warrington v

Contents 11 Side-effects of tricyclic and related antidepressants 181 Karabi Ghose PART IV MONOAMINE OXIDASE INHIBITOR ANTIDEPRESSANTS 12 Efficacy and problems of MAO inhibitor 201 antidepressants Diana Cody and Cosrno Hallstrorn PART V GENERAL MANAGEMENT 13 Management of acute episodes of depression 219 Hilary Standish-Barry 14 The use of electroconvulsive therapy in elderly 235 depressive patients Katy Malcolrn and Malcolrn Peet 15 Drug therapy in the management of treatment- 253 resistant depression in elderly people David M. Shaw 16 Long-term antidepressant treatment in old age 269 Isabel C.A. Moyes 17 Factors influencing the outcome of treatment 279 Klaus P. Ebrneier and George Ashcroft Subject index 291 Pharmacological and therapeutic agents index 295 vi

Contributors Ceorge W. Ashcroft MBChB, DRCOG, DSc, DPM, FRCPE, FRSE, FRCPsych, Professor, Department of Mental Health, University of Aberdeen. Anthony J. Bayer Lecturer, University Department of Geriatric Medicine, University of Wales, College of Medicine, Cardiff Royal Infirmary. Diana Cody MB, BA, MRCPsych, Senior Registrar, Department of Psychologieal Medicine, Hammersmith Hospital, London. John R.M. Copeland MA, MD, FRCP, FRCPsych, DPM, Professor of Psychiatry, and Director Institute of Human Ageing, University of Liverpool. Alec Coppen MD, DSc, FRCP, FRCPsych, Medical Research Council, Neuropsychiatry Research Laboratory, West Park Hospital, Epsom, Surrey. Peter Crome MD, FRCP Edin., Consultant Physician in Geriatric Medicine, Orpington Hospital, Kent, and Clinieal Associate Professor, Department of Medicine, University of Saskatchewan, Canada. Jila Dana-Haeri MD, PhD, Charterhouse Clinieal Research Unit Ud., London. Sheila Dawling BSc, PhD, Principal Biochemist, Poisons Unit, New Cross Hospital, London. Klaus P. Ebmeier Ger. Med. State Exam. MRCPsych, Lecturer, Department of Mental Health, University of Aberdeen. Karabi Chose PhD, MRCP, Senior Lecturer and Honorary Consultant in Geriatrie Medicine, University of Wales College of Medicine, Cardiff. Cosmo Hallstrom MB, BCh, MRCP, MRCPsych, Consultant Psychiatrist, Charing Cross Hospital, London. Cornelius L.E. Katona MA(Cantab), MB, BCh, MRCPsych, Senior Lecturer and Honorary Consultant in Psychiatry with Special Interest in the Elderly, University College and Middlesex School of Medicine and Whittington Hospital, London. vii

Contributors John H. Lazarus MD, FRCP, Senior Lecturer, Oepartment of Medicine, University of Wales College of Medicine, Cardiff. Katy Maleolm Senior Registrar in Psychiatry, Northern General Hospital, Sheffield. Ian McKeith MB, BS, MRCPsych, Senior Lecturer and Consultant Psychiatrist, Oepartment of Psychiatry, University of Newcastleupon-Tyne. Isabel c.a. Moyes* Senior Lecturer and Honorary Consultant in Psychiatry with Special Interest in the Elderly, The London Hospital. M.S. John Pathy Professor of Geriatric Medicine, University of Wales College of Medicine, Cardiff. Malcolm Peet Consultant Psychiatrist, Northern General Hospital, Sheffield. Vimal K. Sharma MB, BS, MD, MRCPsych, Consultant Psychiatrist, Walton Hospital, Liverpool and Honorary Research Fellow, Oepartment of Psychiatry, University of Liverpool. David M. Shaw FRCP, PhO, FRCPsych, Senior Lecturer and Honorary Consultant Psychiatrist, University of Wales College of Medicine, Cardiff. Hilary Standish-Barry MRCPsych, Consultant Psychiatrist, Epsom Oistrict Hospital, Surrey. Steve J. Warrington MA, MD, MRCP, Charterhouse Clinical Research Unit Ud, London. *Sadly, Isabel Moyes died before this book was published (Editor's note). viii

Preface Depression is one of the commonest problems in old age. Yet until recently, old people were systematically exduded from participating in drug trials and similar investigations. As a result, knowledge regarding incidence, natural history and management of depression in the elderly are somewhat limited. It is now well-established that old people are sensitive to most psychotropic drugs and they tend to suffer from adverse effects and side effects of antidepressant drugs more frequently than any other age group. These are considered to be due to age-related physiological changes. In addition, because of the frequent association with multiple pathology, the elderly are likely to receive polypharmacy which further complicates the management of antidepressant drug therapy. The aim of this book is to provide a comprehensive guidance on the drug therapy of depression for the dinicians involved in the health care of the elderly. In the first section, epidemiology, presentations and assessment of depression in old age and neuroendocrine abnormalities observed in patients with depression are briefly discussed. However, it mainly deals with the problems of antidepressant drug therapy, such as which antidepressant to prescribe, how to monitor efficacy and side effects, what is the adequate dose, how long to treat a single episode of depression and who requires long term medication. Information regarding pharmacology, side effects, adverse effects, drug interaction and pharmacokinetics of most currently available drugs are provided. Special emphasis has been given on continuation therapy and the choice of an antidepressant drug and their long term safety. The elderly should not be deprived of a medication for fear of side effects. Quality of their life can be improved by prescribing a prophylactic drug, such as lithium, but dose supervision is required in this population. The safety and efficacy of electroconvulsive therapy are summarized in chapter 14. The factors influencing the out co me of depression and the management of treatment resistant depression are also discussed. In dealing with a book of this kind involving multiple authors from multidisciplinary backgrounds, some degree of overlapping of contents are inevitable. It is also intended to indude as many different opinions ix

Preface as possible on various controversial aspects of clinical management of depression in old age. I would like to express my gratitude to the authors for their valuable contribution and support. I also gratefully acknowledge the help and assistance provided by the editorial staff of Chapman and Hall publishers. KARABI GHOSE x