Posted by Sunnely on March 9, 2002, at 17:35:37
In reply to Help - antidepressant advice for senior?, posted by nona on March 9, 2002, at 3:47:21
I will suppose what you meant by "zombie" from Zoloft is having extrapyramidal symptoms (EPS) in particular "bradykinesia" wherein the individual shows masklike facial appearance, diminished expressiveness, less frequent blinking, slow movement. Zoloft, and so are the other SSRIs, can cause this side effect. This may be due to their ability to enhance the action of serotonin which in turn, inhibits the dopamine action. Aside from this effect, as the brain ages, the dopamine actiivity also diminished. This combination makes the elderly patients probably at highest risk for EPS when using SSRIs and antipsychotic drugs.
Other SSRIs will probably lead to similar side effect. In addition, Prozac, aside from being activating, may also lead to loss of appetite and subsequent weight loss in the elderly. Paxil is more sedating but there have been reports of glaucomatous attack when used in the elderly. Both Prozac and Paxil are potent inhibitors of CYP2D6 enzyme upon which a number of other drugs rely on for metabolism. As you may be aware, it is not uncommon for elderly patients to be on a number of medications for several reasons. This may make them more vulnerable to toxic drug-drug interactions. Luvox and Celexa probably won't fare any better than either Prozac or Paxil. Luvox is a potent inhibitor of CYP1A2 enzyme and moderate inhibitor of other CYP450 enzymes. One positive note about Celexa is that, it weakly interferes with the metabolism of other drugs.
BTW, SSRIs as a group, also appear to induce hyponatremia (low blood sodium) particularly in the elderly. If not detected early, it may lead to acute confusion, agitation, vomiting, and even seizures. It is therefore recommended to check the sodium level periodically in elderly patients who are on SSRIs, especially if there are acute changes in sensorium such as confusion and agitation.
Wellbutrin (not an SSRI) is probably not a good choice if the concern is insomnia. Serzone has sedating effect but there is a concern, although rare, for acute liver failure (now a BLACK BOX WARNING). Aside from this, Serzone potently inhibits the action of CYP3A4 enzyme upon which a number of other drugs rely on for their metabolism. In the elderly, tricyclic antidepressants are probably somewhere at the bottom of choice due to serious concerns for: 1) serious heart rhythm irregularity ("torsades"), 2) delirium, 3) significant drop in blood pressure leading to fall, 4) worsening of glaucoma, prostate problem, constipation, urinary retention.
It appears that Remeron, among the antidepressants, may be the best choice in your relative's case. Not only that it has sedating effect in smaller dose, it may also promote appetite which may be beneficial for the undernourished elderly patients. On the other hand, it may cause dizziness and orthostatic hypotension (drop in blood pressure upon arising) which may lead to fall, not uncommon occurrence in the elderly.
If depression is severe, the patient needs faster relief, and there are serious psychopharmacological concerns, please do not forget that electroconvulsive therapy (ECT) is as effective (if not more effective) and faster acting than the available drug therapy. ECT can be given safely in the elderly.
> I have a relative nearing 70 who is very depressed. She became sort of a zombie on Zoloft and is worried about trying SSRI's again for that reason. Wellbutrin is a possibility but since insomnia is a HUGE problem for her I don't know that it would be the best choice. I wouldn't think the tricyclics would be a great option either because of their effects on the heart.
>
> Does anybody have any other suggestions for antidepressants that are safe for seniors? Are all the SSRI's like Zoloft in creating the zombie effect? Are any better in this regard?
poster:Sunnely
thread:97168
URL: http://www.dr-bob.org/babble/20020307/msgs/97234.html