All depression drugs, regardless of their type, have been shown to be effective in treating elderly patients. First-generation antidepressants, the oldest type, have been used since the 1950s. Dangers associated with them resulted in development of second- and third-generation antidepressants beginning in the 1980s. Selective serotonin reuptake inhibitors, or SSRIs, are second-generation drugs that increase the uptake of a brain chemical called serotonin, which relieves depression. Third-generation antidepressants are a group of antidepressant agents of variable action and are not confined to increasing serotonin levels.
First-Generation Antidepressants
First-generation antidepressants include monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). Today they are mostly used when second- and third-generation depression drugs have failed or cannot be used for whatever reason. TCAs should generally not be used if a patient has a heart problem. MAOIs can cause some serious drug interactions.
Second-Generation Antidepressants
Prozac is probably the best known second-generation depression drug. It is part of a drug class called SSRIs. The launch of SSRIs revolutionized the treatment of depression allowing more people access to treatment and access to doctors who were not psychiatrists but who could treat depression. SSRIs are seen as safer drugs with less side effects, when compared to the first-generation antidepressants. Others SSRIs commonly used in the United States are Paxil, Luvox, Zoloft, Lexapro and Celexa.
Third-Generation Antidepressants
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are considered third-generation depression drugs. SNRIs currently available include Effexor, Cymbalta and Pristiq. Some SNRIs differ from each other in their side-effect profile. Some patients may respond differently to one and not another. The SNRIs give physicians more choice when treating depression. Other third-generation antidepressants include Wellbutrin, Remeron, Desyrel and Serzone.
Considerations
The therapeutic effects of depression drugs vary from person to person. If a patient doesn’t respond to one depression drug they can be switched to another. It is not uncommon for a patient to be switched from one SSRI to another. However, sometimes patients don’t respond at all to drug treatment. According to HelpGuide.org, “a major government study released in 2006 showed that fewer than 50 percent of people become symptom-free on antidepressants, even after trying two different medications. Furthermore, many who do respond to medication slip back into major depression within a short while, despite sticking with drug treatment.”
Side Effects
Side effects are common with all depression drugs. First-generation depression drug side effects are more severe than second- and third-generation depression drugs. Common side effects of SSRIs include sexual problems, drowsiness, sleep difficulties and nausea. According to an article published in Primary Psychiatry, research shows that SSRIs may increase the risk for falls, fractures and bone loss in older adults. Side effects vary according to specific drug for third-generation depression drugs, but nausea, fatigue, weight gain, sleepiness, nervousness, dry mouth and blurred vision are the most common.
