REVERSIBLE AND SELECTIVE INHIBITORS OF MONOAMINE-OXIDASE-A IN THE TREATMENT OF DEPRESSED ELDERLY PATIENTS

The treatment of depression in the elderly population needs a thorough and careful work-up and an aggressive therapeutic approach. Any treat ment initiative in this population often becomes difficult because of accompanying physical illness, concomitant medication, possible degene rative changes in central nervous system and age-related altered metab olic status. Despite unevenness in research findings, pharmacological treatment remains the mainstay of management of depression among elder ly people. Currently available antidepressants, although effective, ar e problematic because of the increased vulnerability of the elderly to side effects. Recent research efforts to improve the efficacy and saf ety of drug treatment of depression resulted in development of reversi ble and selective monoamine oxidase inhibitors of the isoenzyme A (RIM A), with antidepressant efficacy comparable to tricyclic antidepressan ts and newer generation antidepressants. RIMAs include moclobemide, br ofaromine, toloxatone and cimoxatone. Moclobemide is the most investig ated available RIMA for therapeutic use at present. Its absorption and disposition in elderly individuals do not differ significantly from t hose in young healthy volunteers and depressed patients. The results o f present clinical studies show that, in elderly depressed patients, m oclobemide is at least as effective as other antidepressants. Its part icular advantage is, however, that it is as well tolerated in elderly people as in younger people. There are only few significant adverse ev ents, and they are generally less frequent and less severe than those with TCAs. An additional attribute of moclobemide seems also to be its beneficial effect on cognitive functions.