USE OF SEROTONIN SELECTIVE REUPTAKE INHIBITORS IN GERIATRIC DEPRESSION

The treatment of depression can be problematic in the elderly patient. The advent of the serotonin selective reuptake inhibitors (SSRIs) rep resents a significant advance in the treatment of depression. Sufficie nt data from controlled studies now exist on the efficacy and safety o f these agents in geriatric patients to recommend them as a primary tr eatment for major depressive disorder. SSRIs appear to have significan t advantages over older drugs, especially tricyclic agents, in this ag e group. The lack of significant anticholinergic and antihistaminergic side effects results in better tolerability and better compliance. Wh ile SSRIs are not free of side effects, those that occur can usually b e managed in the context of continued treatment of the depressive epis ode. This article reviews data from controlled studies of the treatmen t of geriatric depression for all four available SSRIs in the United S tates-fluoxetine, sertraline, paroxetine, and fluvoxamine (which is ap proved in the United States for treating only obsessive-compulsive dis order). Differences among the SSRIs are examined, particularly with re ference to clinically relevant differences in pharmacokinetics and hep atic isoenzyme inhibition. Principles of clinical management are discu ssed, including dose initiation and titration, side effect management, augmentation and combinations, and length of treatment. Finally, the use of SSRIs in special elderly populations is discussed.