Management Considerations for Late-Life Depression

The prescribing of antidepressants for patients with late-life depression is complicated by a number of factors related to the aging process. As a result of age-related changes in brain neurotransmitters and receptors, elderly patients are generally more sensitive to both the therapeutic and toxic effects of drugs. Drug pharmacokinetics are also altered in the elderly, causing accumulation and reduced clearance and generally necessitating the administration of lower doses than in younger patients. Elderly patients frequently require treatment with multiple drugs owing to concomitant illness, increasing the possibility of drug interactions and causing compliance difficulties. In general, antidepressants should initially be prescribed at a low dose, and then the dose should be increased slowly, if necessary. Since prolonged maintenance therapy is required to prevent relapse or recurrence of depression, tolerability and compliance are also important issues affecting drug choice in elderly patients.