METABOLIC AND PHYSIOLOGICAL CONSEQUENCES OF NORTRIPTYLINE TREATMENT IN THE ELDERLY

The challenge in the pharmacotherapy of affective disorders is shiftin g to maintenance treatment. Hence, there is a need for systematic data on the somatic effects of long-term medication use. Twenty-six depres sed patients (age > 60 yr) treated with therapeutic concentrations of nortriptyline were evaluated after an average of 7 months for changes in lipoproteins and cardiovascular parameters. Twelve patients were te sted for debrisoquine (P450 2D6) metabolic status and creatinine clear ance at these same intervals. There was no significant change in chole sterol levels, but triglycerides and very-low-density lipoproteins (VL DL) were significantly increased. Heart rate was also elevated by a me an of 15 beats per minute, and there were modest but significant incre ases in cardiac conduction parameters. Creatinine clearance declined s ignificantly (by 34%), and blood pressure was unchanged. Small decreme nts in P450 2D6 could be quantitated. Older patients treated with main tenance psychotropic medications should be evaluated at the regular in tervals, particularly with regard to the age-related complications of multiple illness and medications.