Although adverse effects may occur, selective serotonin reuptake inhibitors are generally well tolerated in the elderly

2009 ◽  
Vol 25 (5) ◽  
pp. 19-22
Author(s):  
&NA;
Keyword(s):  
Adverse Effects ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
The Elderly ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin

Clinical comparison of selective serotonin reuptake inhibitors in the treatment of geriatric depression: a review of literature

2000 ◽  
Vol 10 (4) ◽  
pp. 349-373 ◽  
Author(s):  
Richard Marc Patel
Keyword(s):  
Side Effect ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Relevant Literature ◽  
The Elderly ◽  
The United States ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Geriatric Depression ◽  
First Choice

IntroductionWith their ease of administration, relatively benign side-effect profile and safety in overdose, in the United States the selective serotonin reuptake inhibitors (SSRIs) have become de facto first choice in the treatment of geriatric depression, displacing tricyclic antidepressants (TCAs). In this paper, the relevant literature regarding neurochemistry, kinetics, dosing, efficacy and differential side-effect profiles of citalopram, fluvoxamine, fluoxetine, sertraline, and paroxetine, the five currently available SSRIs in the USA, will be reviewed with special emphasis on geriatric data. Of late, considerable controversy has been generated regarding whether SSRIs are as effective as TCAs in severe and melancholic depressive subtypes. This important issue will be explored and the relative utility of all the SSRIs in the elderly patient compared and contrasted. Finally, reasons for difficulties in comparing results across studies will be elucidated.

Discontinuing or Switching Selective Serotonin-Reuptake Inhibitors

2002 ◽  
Vol 36 (4) ◽  
pp. 578-584 ◽  
Author(s):  
Scott A Bull ◽  
Enid M Hunkeler ◽  
Janelle Y Lee ◽  
Clayton R Rowland ◽  
Todd E Williamson ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Adverse Effects ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Early Discontinuation ◽  
Telephone Surveys ◽  
Recurrent Case ◽  
Frequent Reason

OBJECTIVE: To describe reasons for discontinuing or switching selective serotonin-reuptake inhibitors (SSRIs) at 3 and 6 months after starting treatment, and to identify information provided to patients that may help prevent premature discontinuation of medication. METHODS: Telephone surveys were conducted at 3 and 6 months after patients (n = 672) were started on an SSRI for a new or recurrent case of depression. RESULTS: Significantly more patients discontinued or switched their SSRI because of an adverse effect within the first 3 months of starting (43%) compared with the second 3 months (27%; p = 0.023). The adverse effect most frequently reported as the reason for early discontinuation or switching was drowsiness/fatigue (10.2%), followed by anxiety, headache, and nausea — All at just over 5%. The odds ratio for discontinuation was 61% less in patients who recalled being told to take the medication for at least 6 months compared with those who did not (OR 0.39; p < 0.001). Patients who recalled being informed of potential adverse effects increased their reported incidence of mild to moderate adverse effects by 55% (OR 1.55; p < 0.05) without affecting rates of premature discontinuation (OR 1.06; p = 0.77). CONCLUSIONS: Adverse effects are the most frequent reason for discontinuing or switching SSRIs within the first 3 months of treatment. Patients are more likely to continue taking their antidepressant if they fully understand how long to take the medication. Informing patients of potential adverse effects does not appear to prevent premature discontinuation, but may increase the patient's awareness and reporting of mild to moderate adverse effects.

The Impact of Trends in Psychotropic Prescribing on the Method of Suicide in the Elderly

2005 ◽  
Vol 45 (2) ◽  
pp. 115-120 ◽  
Author(s):  
Ajit Shah ◽  
Lubbaba Lodhi
Keyword(s):  
Psychotropic Drugs ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
The Elderly ◽  
Serotonin Reuptake Inhibitors ◽  
Prescribing Patterns ◽  
Selective Serotonin ◽  
Hypnotics And Sedatives ◽  
Suicide Rates ◽  
Elderly Suicide

Suicide rates in the elderly have declined in many countries in recent years. This decline has been reported to be associated with increased prescribing of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), antipsychotics and antimanic drugs and reduced prescribing of barbiturates, hypnotics and sedatives. This study examined the relationship between prescribing patterns of individual psychotropic drugs and suicide rates by specific methods of elderly suicides. There was a negative correlation between the prescription of tricyclic antidepressants, selective serotonin reuptake inhibitors, antipsychotics, antimanic drugs and non-opiate analgesics and a decline in elderly suicide rates due to poisoning by solid and liquid substances, hanging, strangulation and suffocation, drowning, firearms and explosives, and jumping from high places. There was a positive correlation between the prescription of barbiturates, hypnotics and sedatives and elderly suicide rates due to poisoning by solid and liquid substances, hanging, strangulation and suffocation, drowning, firearms and explosives, and jumping from high places. This study demonstrated that changes in prescribing patterns of individual psychotropic drugs do influence elderly suicide rates of the commonly used methods of suicide and suggest that this may be due to more accurate diagnostic-specific prescribing of psychotropic drugs.

Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder: A meta-analysis of common side effects in acute treatment

2019 ◽  
Vol 33 (11) ◽  
pp. 1340-1351 ◽  
Author(s):  
Laiana A Quagliato ◽  
Fiammetta Cosci ◽  
Richard I Shader ◽  
Edward K Silberman ◽  
Vladan Starcevic ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Risk Factor ◽  
Panic Disorder ◽  
Adverse Effects ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Meta Analysis ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Short Term

Background:Benzodiazepines (BZs) and selective serotonin reuptake inhibitors (SSRIs) are effective in the pharmacologic treatment of panic disorder (PD). However, treatment guidelines favor SSRIs over BZs based on the belief that BZs are associated with more adverse effects than SSRIs. This belief, however, is currently supported only by opinion and anecdotes.Aim:The aim of this review and meta-analysis was to determine if there truly is evidence that BZs cause more adverse effects than SSRIs in acute PD treatment.Methods:We systematically searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and clinical trials register databases. Short randomized clinical trials of a minimum of four weeks and a maximum of 12 weeks that studied SSRIs or BZs compared to placebo in acute PD treatment were included in a meta-analysis. The primary outcome was all-cause adverse event rate in participants who received SSRIs, BZs, or placebo.Results:Overall, the meta-analysis showed that SSRIs cause more adverse events than BZs in short-term PD treatment. Specifically, SSRI treatment was a risk factor for diaphoresis, fatigue, nausea, diarrhea, and insomnia, whereas BZ treatment was a risk factor for memory problems, constipation, and dry mouth. Both classes of drugs were associated with somnolence. SSRIs were associated with abnormal ejaculation, while BZs were associated with libido reduction. BZs were protective against tachycardia, diaphoresis, fatigue, and insomnia.Conclusion:Randomized, blinded studies comparing SSRIs and BZs for the short-term treatment of PD should be performed. Clinical guidelines based on incontrovertible evidence are needed.

Efficacy and Tolerability of Moclobemide in Comparison with Placebo, Tricyclic Antidepressants, and Selective Serotonin Reuptake Inhibitors in Elderly Depressed Patients: A Clinical Overview

1997 ◽  
Vol 42 (10) ◽  
pp. 1043-1050 ◽  
Author(s):  
Roman Amrein ◽  
Max Stabl ◽  
Stephan Henauer ◽  
Eva Affolter ◽  
Iris Jonkanski
Keyword(s):  
Adverse Events ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Safety Data ◽  
The Elderly ◽  
Similar Efficacy ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Depressed Patients ◽  
Tetracyclic Antidepressants

Objective: To review the efficacy and safety of moclobemide in comparison with TCAs(for our purposes, “TCAs” will represent tricyclic and tetracyclic antidepressants, including maprotilin and mianserin) and selective serotonin reuptake inhibitors (SSRIs) in elderly depressed patients. Methods: The efficacy data reviewed were obtained from the following sources: 1) results of published studies in the elderly; 2) data on patients aged ≥ 60 years extracted from all available controlled trials in adults (≥ 18 years) in which moclobemide was compared with TCAs or SSRIs; and 3) the adverse events were extracted for patients aged ≥ 60 years from the safety data base of all available comparative short-term studies with moclobemide versus TCAs, SSRIs, or placebo and of long-term studies with moclobemide. Results: The data show that moclobemide is an effective antidepressant in depressed patients aged ≥ 60 years. The response rate to moclobemide was 50% to 55% in this population. Moclobemide was more effective than placebo and was of similar efficacy to the TCAs and the more recently introduced SSRIs. The tolerability of moclobemide was rated as “very good” or “good” in almost 90% of these patients, which was better than the tolerability of TCAs and similar to that of SSRIs. Patients without any adverse events were more frequently found in the moclobemide group than in those treated with TCAs (P < 0.01) or SSRIs (P < 0.01). Adverse events of the anticholinergic type were more frequent with TCAs than with moclobemide (P < 0.001), and nausea was found 3 times more frequently with SSRIs than with moclobemide (P < 0.01). Conclusions: Moclobemide is an effective and well-tolerated antidepressant for the treatment of elderly depressed patients.

Female Sexual Side Effects Associated with Selective Serotonin Reuptake Inhibitors: A Descriptive Clinical Study of 33 Patients

1995 ◽  
Vol 25 (3) ◽  
pp. 239-248 ◽  
Author(s):  
Winston W. Shen ◽  
Jeffrey H. Hsu
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Adverse Effects ◽  
Serotonin Reuptake ◽  
Female Sexual Dysfunction ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Spontaneous Remission ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Sexual Side Effects

Objective: After the advent of selective serotonin reuptake inhibitors on the U.S. market in 1988, American psychiatrists have been faced with more choices of antidepressants for the treatment of depression. The prescribing of SSRIs has been increasing in popularity because they are easily titrated by the physicians and tolerated by patients. However, the SSRI use is frequently associated with female sexual dysfunction. The aim of this study was to describe these SSRI-associated female sexual side effects. Methods: In a retrospective series, clinic records of 110 female SSRI-treated outpatients were reviewed for loss of or decreased libido, orgasmic disturbances (anorgasmia or delayed orgasm), as well as clinical management patterns to alleviate sexual side effects. Results: Twenty-one fluoxetine-, nine paroxetine-, and five sertraline-treated cases with female sexual inhibition were identified. The fates of SSRI-associated sexual adverse effects and clinical managements of restoring these side effects were described. Conclusions: With some limitations in interpreting the data, the findings of this study suggest that SSRI-associated female sexual dysfunction occurs at a higher rate than we previously thought, equal potentials in implicating female sexual side effects among three SSRIs, and the absence or the low incidence of female sexual adverse effects from bupropion, and that these side effects can be managed by waiting for a spontaneous remission, dosage reduction of SSRIs, substitution with bupropion and other antidepressants, or the use of an antidote.

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