Despite several recent trials establishing the efficacy of newer antidepressant medications, particularly the serotonin selective reuptake inhibitors (SSRIs) in elderly patients, there is considerable underuse of these therapies and/or inadequate treatment of depression in this patient population. Several factors may contribute to this situation, including underdiagnosis of depression in the elderly and a lack of compliance with a therapeutic regimen. However, a very important but overlooked factor may be that the efficacy data from controlled trials have not been translated into clearly defined therapeutic guidelines in real-world settings.
This presentation will briefly review the currently available data from controlled trials of SSRIs in the elderly and will translate those findings to address commonly encountered pragmatic issues in clinical settings. These will include initiation of treatment, dosing, duration of acute and maintenance phases of therapy, commonly encountered adverse effects, drug-drug interactions, and realistic therapeutic expectations, including switching strategies. Finally, special issues pertaining to seriously medically ill patients, including the potential of drug-drug interactions of certain mood-enhancing drugs, will be discussed.
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