Antidepressant Treatment of Depression in the Elderly: Efficacy and Safety Considerations

Depression in the elderly is a significant clinical problem which is likely to endure as an ongoing issue as the cohort of individuals aged over 65years continues to increase as a proportion of the total population. While there are a multiplicity of approaches to the treatment of depression, the mainstay for moderate to severe cases is pharmacotherapy. The majority of extant antidepressants have demonstrated efficacy, at least in short term (6-12weeks) clinical evaluations. There is demonstrable efficacy over and above that of placebo in the majority of clinical trials for most agents. Within the classes of antidepressants there is no difference between individual agents, while between classes differences have not been demonstrated consistently. Thus, there appears to be little to choose between the various agents. However, considerations other than efficacy play a role in the choice of an antidepressant for an individual patient. A systematic review of the efficacy of antidepressant agents based on trials in elderly populations is presented. Factors influencing the choice of a medication over and above efficacy are presented along with a brief review of adverse events of particular concern in elderly patients. A considerable proportion of elderly patients have comorbid medical conditions, which may also influence the choice of agent due to drug-drug interaction considerations. A brief overview of interactions likely to influence medication selection is also canvassed. While there is every reason to be optimistic about outcomes in elderly patients, there are still unanswered questions about antidepressant efficacy in this population: effectiveness in long-term treatment and in the population of so-called ‘old-old’ elderly are principal among them.

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Efficacy of Citalopram in the prevention of recurrent depression in elderly patients: Placebo-controlled study of maintenance therapy

The British Journal of Psychiatry ◽

10.1192/bjp.181.1.29 ◽

2002 ◽

Vol 181 (1) ◽

pp. 29-35 ◽

Cited By ~ 62

Author(s):

René Klysner ◽

Jesper Bent-Hansen ◽

Hanne L. Hansen ◽

Marianne Lunde ◽

Elisabeth Pleidrup ◽

...

Keyword(s):

Major Depression ◽

Elderly Patients ◽

Rating Scale ◽

The Elderly ◽

Term Treatment ◽

Fixed Dose ◽

Controlled Study ◽

Recurrence Time ◽

Long Term Treatment

BackgroundThe highly recurrent nature of major depression in the young and the elderly warrants long-term antidepressant treatment.AimsTo compare the prophylactic efficacy of citalopram and placebo in elderly patients; to evaluate long-term tolerability of citalopram.MethodOut-patients, ⩾65 years, with unipolar major depression (DSM – IV: 296.2 x or 296.3 x) and Montgomery – Åsberg Depression Rating Scale score ⩾22 were treated with citalopram 20–40 mg for 8 weeks. Responders continued on their final fixed dose of citalopram for 16 weeks before randomisation to double-blind treatment with citalopram or placebo for at least 48 weeks.ResultsNineteen of the 60 patients using citalopram v. 41 of the 61 patients using placebo had recurrence. Time to recurrence was significantly different between citalopram— and placebo-patients, in favour of citalopram (log-rank test, P < 0.0001). Long-term treatment was well tolerated.ConclusionsLong-term treatment with citalopram is effective in preventing recurrence of depression in the elderly and is well tolerated.

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565 The tissue effects of long-term treatment with ACE inhibitor and metoprolol in elderly patients with congestive heart failure (CHF) and preserved systolic function

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(06)80362-0 ◽

2006 ◽

Vol 5 (1) ◽

pp. 127-127

Author(s):

O SOYA ◽

O KURYATA

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Elderly Patients ◽

Ace Inhibitor ◽

Systolic Function ◽

Term Treatment ◽

Tissue Effects ◽

Long Term Treatment

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Evaluation of Small Molecule Combinations against Respiratory Syncytial Virus In Vitro

Molecules ◽

10.3390/molecules26092607 ◽

2021 ◽

Vol 26 (9) ◽

pp. 2607

Author(s):

Yuzhen Gao ◽

Jingjing Cao ◽

Pan Xing ◽

Ralf Altmeyer ◽

Youming Zhang

Keyword(s):

Respiratory Syncytial Virus ◽

Confidence Interval ◽

The Elderly ◽

Term Treatment ◽

Fusion Inhibitors ◽

Long Term Treatment ◽

Statistical Program ◽

Syncytial Virus

Respiratory syncytial virus (RSV) is a major pathogen that causes severe lower respiratory tract infection in infants, the elderly and the immunocompromised worldwide. At present no approved specific drugs or vaccines are available to treat this pathogen. Recently, several promising candidates targeting RSV entry and multiplication steps are under investigation. However, it is possible to lead to drug resistance under the long-term treatment. Therapeutic combinations constitute an alternative to prevent resistance and reduce antiviral doses. Therefore, we tested in vitro two-drug combinations of fusion inhibitors (GS5806, Ziresovir and BMS433771) and RNA-dependent RNA polymerase complex (RdRp) inhibitors (ALS8176, RSV604, and Cyclopamine). The statistical program MacSynergy II was employed to determine synergism, additivity or antagonism between drugs. From the result, we found that combinations of ALS8176 and Ziresovir or GS5806 exhibit additive effects against RSV in vitro, with interaction volume of 50 µM2% and 31 µM2% at 95% confidence interval, respectively. On the other hand, all combinations between fusion inhibitors showed antagonistic effects against RSV in vitro, with volume of antagonism ranging from −50 µM2 % to −176 µM2 % at 95% confidence interval. Over all, our results suggest the potentially therapeutic combinations in combating RSV in vitro could be considered for further animal and clinical evaluations.

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