Efficacy of venlafaxine in geriatric depression

Geriatric patients With major depression present clinical challenges not en countered iii younger individuals, including a greater incidence of medical comorbidity, higher rates of multiple medication use, changes in drug meta bolism due to age or physical illness, and increased sensitivity to antidep ressant sine effects. Nevertheless, successful treatment of depressive diso rders in the elderly improves mental and physical functioning, decreases mo rbidity ann perhaps mortality and enhances quality of life. Recent research indicates that newer antidepressants ale effective for late life depressio n and safer for older individuals. Among newer antidepressants, venlafaxine has a pharmacological profile that makes it nit attractive choice for geri atric patients. It has limited potential to interact with other medications because it only Weakly inhibits the cytochrome P450 system and binds to pl asma proteins at a low level. Dosing may have to be adjusted for patients w ith renal failure, but typically not for those with liver disease or other medical conditions. Data from three double-blind and four open clinical tri als support the safety and efficacy of venlafaxine for geriatric depression . Patients may experience transient, generally tolerable sine effects such as insomnia, nausea, agitation, or dry month early in treatment, bat more s erious problems such as falls or cardiac rhythm disturbances seem to be rar e. Treatment emergent hypertension occurs in a small percentage of older pa tients, generally at doses above 150 mg/day. Finally, emerging data suggest that venlafaxine may be effective for conditions such as stroke, anxiety, and Iseuropnthic pain that frequently accompany depressive disorders in the elderly. (C) 2000 Wiley-Liss, Inc.