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SSRIs Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline SNRIs

Depression in Older Adults Depression is common in older adults, and especially prevalent in older adults with chronic illnesses. TREATMENT OF NON-PSYCHOTIC MAJOR DEPRESSIVE DISORDER IN PRIMARY CARE. EPIDEMIOLOGY OF DEPRESSION

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SSRIs Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline SNRIs

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  1. Depression in Older Adults Depression is common in older adults, and especially prevalent in older adults with chronic illnesses TREATMENT OF NON-PSYCHOTIC MAJOR DEPRESSIVE DISORDER IN PRIMARY CARE • EPIDEMIOLOGY OF DEPRESSION • A diagnosis of depression is associated with increased length of hospitalization, increased medical costs, and a higher rate of readmission. • Risk factors of depression include specific diagnoses of MI, CVA, or malignancy. • 50% of patients who commit suicide were seen by a provider in the preceding 30 days. • Risk factors for suicide: living alone, male, alcoholism, comorbid physical illnesses. • Suicide is a significant risk in older adults, men more than women. • Older men are at highest risk for completed suicide (15% of population, 25% of suicides). • Older individuals are more susceptible to medication toxicity such as serotonin syndrome. • Early dementia may co-occur with late onset depression. Pearls of Wisdom • Pearls for SSRIs: • Sertraline is the preferred SSRI in patients with CAD/CVD. • Fluoxetine has a very long half-life; avoid in patients who have had ADRs to previous SSRIs. • Hyponatremia – Risk with SSRIs, SNRIs; increased risk in elderly, women and patients on thiazides. • Sexual Dysfunction – Sexual dysfunction can be seen when treating depression with pharmacologic therapies. Of the treatment options, mirtazapine and buproprionhave the lowest incidence of sexual dysfunction. • Pearls for SNRIs and Other: • Mirtazapine – Good in patients with decreased appetite and insomnia. • Avoid SNRIs and Buproprionin patients with uncontrolled hypertension (or those on >2 antihypertensives). • Duloxetine – Potential complications include abnormal bleeding and hepatic failure. Partial Response No response Partial Response No response Reference: UpToDate Key: BUP = bupropion SR/XL BUS = buspirone CBT = cognitive behavior therapy MRT = mirtazapine SNRI = serotonin-noreprinephrine reuptake inhibitor SSRI = selective serontonin reuptake inhibitor Medications Associated with Depression No response SSRIs Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline SNRIs Duloxetine Venlafaxine Other Mirtazapine Buproprion Varenacline Benzodiazepines & other sedative hypnotics Opiates Isotretinoin Finasteride (high dose) Leukotriene antagonists Anti-hypertensives – (Weak Association) CBT (Cognitive Behavioral therapy) is an option before starting or in combination with pharmacotherapy at any stage in the algorithm. Funded by D.W. Reynolds Foundation

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