Abstract
Treatment of the depressed elderly patient requires careful appraisal of the nature and severity of the patient’s affective disturbance. A program is then selected that will offer the optimum balance between the disruptive effect of the symptoms and the antidepressant treatments, most of which have a high potential for toxicity in older people. Milder depressions may be successfully treated with psychotherapy or the psychostimulants. More severe depressive states usually require treatment with cyclic antidepressants, monoamine oxidase inhibitors, or electroconvulsive therapy. Antidepressant treatment is often undertaken in patients with cardiovascular disease or preexisting cognitive dysfunction, which emphasizes the need for special care in treating this population.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Abernathy, D.R., Kerzner, L., 1984, Age effects on alpha-1-acid glycoprotein Concentration and imipramine plasma protein binding, J. Am. Geriat.Soc., 32: 705.
Abiuso, P., Dunkleman, R., Proper, M., 1975, Electroconvulsive therapy in patients with pacemakers, J. Am. Med. Assoc., 240: 2459.
Ables, S., Gwirtsman, H., Halaris, A., Shah, P., Schwarcz, G., Hill, M.A., 1984, Comparative cardiac effects of matprortiline and doxepin, J. Clin. Psychiatry, 45: 460.
Ashford, W., Ford, C.V., 1976, Use of monoamine oxidase inhibitors in elderly patients, Am. J. Psychiatry, 136: 1466.
Bertilsson, L., Mellstram, B., Sjoqvist, P., 1979, Pronounced inhibition of noradrenaline uptake by 10-hydroxy metabolites of nortriptyline, Life Sci, 25: 285.
Borson, S., Raskind, M., 1986, Antidepressant resistant depression in the elderly, J. Am. Geriat. Soc., 34: 245.
Branconnier, R.J., Cole, J.O., 1981, Effects of acute administration of trazodone and amitriptyline on cognition, cardiovascular function and salivation in the normal geriatric patient, J. Clin. Psychopharmacol., 1: 2.
Brown, R.P., Kocsis, J.H., Glick, I.D., 1984, Efficacy and feasibility of high dose tricyclic antidepressant treatment in elderly delusional depressives, J. Clin. Psychopharmacol., 4: 315.
Cole, J.O., Branconnier, R., Saloman, M., Dessain, E., 1983, Tricyclic use in the cognitively impaired elderly, J. Clin. Psychiatry, 44: 14.
Charatan, F.B., 1985, Depression and the elderly: Diagnosis and treatment, Psych. Ann., 15: 313.
Cutler, N.R., Zavendil, A.P. III, Eisdorfer, C., Ross, R.J., Potter, W.Z., 1981, Concentrations of desipramine in elderly females are not elevated, Am. J. Psychiatry, 138: 1235.
Feighner, J.P., Cohn, J.B., 1985, Double-blind comparative trials of fluoxetine and doxepin in geriatric patients with major depressive disorder, J. Clin. Psychiatry, 46: 20.
Fraser, R.M., Glass, I.B., 1978, Recovery from ECT in elderly patients, Br. J. Psychiatry, 133: 524.
Friedel, R.O., 1975, Relationship of blood levels of Sinequan to clinical effects in the treatment of depression in aged patients, in: “A Monograph of Recent Clinical Studies,” J. Mendels, ed., Excerpta Medical. 1975.
Gallagher, D.E., Thompson, S.W., 1983, Effectiveness of psychotherapy for both endogenous and nonendogenous depression in older adult outpatients, J. Gerontol., 38: 707.
Gerner, R.H., 1984, Antidepressant selection in the elderly, Psychosomatics, 25: 528.
Georgotas, A., Fridman, E., McCarthy, M., 1983, Resistant geriatric depressions and therapeutic response to monoamine oxidase inhibitors, Biol. Psychiatry, 18: 195.
Goff, D.C., Jenike, M.A., 1986, Treatment-resistant depression in the elderly, J. Am. Geriat. Soc., 34: 63.
Hrdina, P.D., Rovei, V., Henry, J.F., 1980, Comparison of single dose pharmacokinetics of imipramine and maprotiline in the elderly, Psycho-pharmacology, 70: 29.
Hui, K.K., 1983, Hypertensive crisis induced by interaction of clonidine with imipramine, J. Am. Geriat. Soc., 31: 164.
Jarvik, L.F., Mintz, J., Steuer, J., 1982, Treating geriatric depression: A 26-week interim analysis, J. Am. Geriat. Soc., 30: 713.
Jauer, P., Weller, M., Hirsch, S.R., 1979, Electroconvulsive therapy for a patient with a cardiac pacemaker, Br. Med. J., 1: 90.
Javaid, J.I., Hendricks, K., Davis, J.M., 1983, Alpha-1-acid glycoprotein involvement in high affinity binding of tricyclic antidepressants to human plasma, Biochem. Pharmacol., 32: 1149.
Jenike, M.A., 1984, Use of monoamine oxidase inhibitors in elderly depressed patients, J. Am. Geriat. Soc., 32: 571.
Jenike, M.A.,1985, “Handbook of Geriatric Psychopharmacology”, PSG Publishing, Littleton, N.J.
Kantor, S.J., Glassman, A.H., 1980, The use of tricyclic antidepressant drugs in geriatric patients, in: “Psychopharmacology of Aging, ” C. Eisdorfer, W.E. Fann, eds., Spectrum, New York.
Kaplitz, S.E., 1975, Withdrawn apathetic geriatric patients responsive to methylphenidate, J. Am. Geriat. Soc., 23: 271.
Karliner, W., 1978, Cardiovascular disease and ECT, Psychosomatics, 19: 238.
Karliner, W., 1978, ECT for patients with CNS disease, Psychosomatics, 19: 781.
Kayton, W., Raskind, M., 1986, Treatment of depression in the medically ill elderly with methylphenidate, Am. J. Psychiatry, 137: 963.
Lemberger, L., Bergstrom, R.F., Woten, R.L., Farid, N.A., Enas, G.G., Aronoff, G.R., 1985, Fluoxetine: Clinical pharmacology and physiologic disposition, J. Clin. Psychiatry, 46: 14.
Lipsey, J.R., Pearlson, G.D., Robinson, R.G., 1984, Nortriptyline treatment of post-stroke depression: A double-blind study, Lancet, 1: 297.
Lipzin, B., 1984, Treatment of mania, in: “Clinical Geriatric Psychopharmacology,” C. Salzman, ed., McGraw-Hill, New York.
Nelson, J.C., Jatlow, P.I., Block, J., Quinlan, D.M., Bowers, M.B., 1982, Major adverse reaction during desipramine treatment, Arch. Gen. Psychiatry, 39: 1419.
Nelson, J.C., Jatlow, P.I., Quinlan, D.N., Bowers, M.B., 1982, Desipramine plasma concentration and antidepressant response, Arch. Gen. Psychiatry, 39: 1419.
Nelson, J.C., Jatlow, P.I., Mazure, C., 1985, Desipramine plasma levels and response in elderly melancholic patients, J. Clin. Psychopharmacol., 5: 217.
Pettinati, H.M., Bonner, K.M., 1984, Cognitive functioning in depressed geriatric patients with a history of ECT, Am. J. Psychiatry, 141: 49.
Preskorn, S.H., Mac, D.S., 1985, Plasma levels of amitriptyline: Effect of age and sex, J. Clin. Psychiatry, 46: 276.
Robinson, D.S., 1981, Monoamine oxidase inhibitors and the elderly, in: “Age and the Pharmacology of Psychoactive Drugs,”, A. Raskin, S.Â. Robinson, J. Levine, eds., Elsevier, New York.
Robinson, R.G., Lipsey, J.R., Price, T.R., 1985, Diagnosis and clinical management of post-stroke depression, Psychosomatics, 26: 769.
Salzman, C., 1981, Stimulants in the elderly, in: “Age and the Pharmacology of Psychoactive Drugs,”, A. Raskin, D.S. Robinson, J. Levine, eds., Elsevier, New York.
Salzman, C., 1982, Key concepts in geriatric psychopharmacology-Altered pharmacokinetics and polypharmacy, Psychiat. Clin. N. Amer., 5: 181.
Salzman, C., 1982, Electroconvulsive therapy in the elderly patient, Psychiat. Clin. N. Amer., 5: 191.
Salzman, C., 1984, Neurotransmission in the aging central nervous system, in: “Clinical Geriatric Psychopharmacology,”, C. Salzman, ed., McGraw-Hill, New York.
Salzman, C., 1985, Clinical guidelines for the use of antidepressant drugs in geriatric patients, J. Clin. Psychiatry, 46: 46.
Salzman, C., 1985, Geriatric Psychopharmacology, Ann. Rev. Med., 36: 217.
Salzman, C. 1985, Clinical use of antidepressant blood levels and the electrocardiogram, New Eng. J. Med., 313: 512.
Salzman, C., 1986, Caution urged in using MAOI’s with the elderly (letter to the editor), Am. J. Psychiatry, 143: 118.
Salzman, C., van der Kolk, B.A., Shader, R.I., 1975, Psychopharmacology and the geriatric patient, in: “Manual of Psychiatric Therapeutics,” R.I. Shader, ed., Little Brown, Boston.
Salzman, C. van der Kolk, B.A., 1984, Treatment of depression, in: “Clinical Geriatric Psychopharmacology,” C. Salzman, ed., McGraw-Hill, New York.
Smith, R.C., Reed, K., Leelavathi, D.E., 1980, Pharmacokinetics and the effects of nortriptyline in geriatric depressed patients, Psychopharm. Bull., 16: 54.
Steuer, J K., 1982, Psychotherapy for depressed elders, in: “Depression in Late Life,” D.G. Blazer, ed., Mosby, St. Louis.
Ward, N.G., Bloom, V.L., Wilson, L., Raskind, M., Raisys, V.A., 1982, Doxepin plasma levels and the therapeutic response in depression: preliminary finding, J. Clin. Psychiatry, 2: 126.
Weiner, R.D., 1982, The role of ECT in the treatment of depression in the elderly, J. Am. Geriat. Soc., 30: 710.
Ziegler, V.E., Biggs, J.T., 1977, Tricyclic plasma levels: Effect of age, race, sex, and smoking, J. Am. Med. Assoc., 238: 2167.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1987 Springer Science+Business Media New York
About this chapter
Cite this chapter
Salzman, C. (1987). Treatment of the Depressed Elderly Patient. In: Altman, H.J. (eds) Alzheimer’s Disease. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-6414-0_15
Download citation
DOI: https://doi.org/10.1007/978-1-4615-6414-0_15
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4615-6416-4
Online ISBN: 978-1-4615-6414-0
eBook Packages: Springer Book Archive