The National Institute of Mental Health reports depression as one of the diseases commonly associated with suicide in older adults (see Reference 1). Unfortunately, most depression in the elderly goes unrecognized and untreated. Older adults can experience bouts of sadness due to changes in their health and social structure, but persistent depression is not a normal part of aging. A physician can prescribe an antidepressant medication to treat depression in the elderly.
Signs of Depression in the Elderly
A depressed older adult might exhibit memory problems, confusion, loss of appetite, insomnia, irritability, and delusions. Additional signs include vague complaints, moving in a slow manner, seeking help, and a demanding behavior, says the National Alliance on Mental Illness, or NAMI. A physical exam complete with blood tests and a medication history can rule out a medical illness or a medication as the cause of the depression.
Classes of Drugs to Treat Depression in the Elderly
Four classes of medications can effectively treat depression in the elderly: Selective serotonin reuptake inhibitors, or SSRIs, norepinephrine and serotonin reuptake inhibitors, or NSRIs, tricyclic antidepressants and monoamine oxidase inhibitors, or MAOIs. SSRIs have become the first line of drug therapy for depression in the elderly because of their effectiveness and fewer side effects, but if an SSRI fails, a medication from another class may prove beneficial.
Selective Serotonin Reuptake Inhibitors SSRIs and Serotonin and Norepinephrine Reuptake Inhibitors NSRI
SSRIs blocks the reabsorption of serotonin by nerve cells in the brain. The Mayo Clinic says this causes an increase in the amount of serotonin available to send nerve impulses to improve mood. The SSRIs approved by the FDA, or the Food and Drug Administration, include Celexa, or citalopram, Lexapro, or escitalopram, Paxil, or paroxetine, Zoloft, or sertraline and Prozac, or fluoxetine. The SNRIs work like the SSRIs, but increase levels of both serotonin and norepinephrine to elevate mood. The SNRIs approved by the FDA include Cymbalta or duloxetine, Effexor, or venlafaxine, and Pristiq, or desvenlafaxine.
Tricyclic Antidepressants and Monoamine Oxidase Inhibitors
Tricyclic antidepressants generally are not used to treat depression in the elderly because they can cause memory problems, confusion and hallucination, according to the Mayo Clinic. However, when an SSRI fails to work, low dosages of amitriptyline at night can help to treat depression and insomnia in the elderly. Because of their severe side effects and interaction with foods containing tyramine, the use of a monoamine oxidase inhibitor is reserved for treatment-resistant depression.
Inappropriate Antidepressants for Use in the Elderly
Antidepressants deemed inappropriate for use in the elderly because the risk of side effects outweighs the benefits include amitriptyline, doxepin, fluoxetine and imipramine, according to an article in the "Journal of the American Medical Association."
Alternative Treatments of Depression in the Elderly
ECT, or electroconvulsive therapy, sends a small shock to the brain, inducing a seizure and causing increased blood flow and release of chemicals in the brain, resulting in feelings of happiness and calmness.
The FDA also approved the use of transcranial magnetic stimulation, or TMS, for mildly depressed elderly who fail to respond to medication. Transcranial magnetic stimulation uses magnetic fields introduced by an electromagnetic coil to stimulate nerve cells in the brain and improve mood, according to the Mayo Clinic.
References
- National Institute of Mental Health "Older Adults: Depression and Suicide Facts"
- National Alliance on Mental Illness "Depression in Older Persons Fact Sheet
- The MayoClinic.com "Depression (major depression)
- JAMA "Inappropriate Medications and Classes to Avoid in Elderly Patients"
- The Use of Electroconvulsive Therapy in the Elderly
