Higher frequency of side effects in older patients under antidepressants

reference

Sobieraj DM, Martinez BK, Hernandez AV, et al. Side effects of pharmacological treatments of severe depression in older adults. j am Geriatr Soc . 2019; 67 (8): 1571-1581.

objective

Assessment of the side effects of pharmacological antidepressants for the treatment of major depression (MDD) in adults aged 65 and over.

draft

meta -analysis of 19 randomized controlled studies and 2 observation studies, most of which took into account the treatment in the acute phase (<12 weeks) of MDD with medium severity.

participant

patients aged 65 and over with MDD, the low-dose antidepressants, including selective serotonin reuptake inhibitors (SSRIS), serotonin noradrenalin reuptake inhibitor (SNRIS), bupropion, mirtazapine, trazodone, vilazodone or pre-tioxetin, were obtained with patients. Placebo or non -pharmacological therapy.

study parameters evaluated

Unwanted events during the treatment of MDD, such as arrhythmias, cognitive impairment, falls, fractures, hospital stays, mortality and QTC extension. Serious undesirable events and demolitions due to unwanted events were also evaluated.

primary result measurements

The various pharmacological treatments were compared with regard to the frequency of unwanted events.

important knowledge

There were 3 key results in this meta analysis:

1. In patients aged 65 or older, both SSRIS and SNRIS were associated with significantly more degrees of study due to general unwanted events than placebo.
2. In the acute phase of treatment (<12 weeks), in patients who were prescribed snris but no SSRIs, compared to placebo, undesirable events occurred.
3. The Snri Duloxetin increased the number of falls in older patients, especially in patients with cardiovascular diseases, a fact that was not reported too little in the original studies.

practice implications

Significant depression symptoms are widespread in older people, with rates from 15 % to 20 % in adults in the community and higher in people with a medical illness or in a facility. 1 depression symptoms in seniors can be different from non-seniors. As a result, depression may not meet the usual criteria for severe depression. In general, older patients experience more somatic complaints and cognitive symptoms, with less complaints about a sad or dysphoric mood. Depression is often seen in older people as agitability, hypochondria or dementia syndrome, and these can often occur without complaints about sadness.

prescription antidepressants are a problem for older patients due to the slower release of medication and the greater probability of interactions, since this population group generally takes up more medication. The American Geriatric Society recommends that SSRIS and tricyclic antidepressants (TCA) should not be prescribed with a prehistory or a significant risk of fall or fracture.

This study is a helpful memory that even with the medication that is considered to be "safer" for seniors, there are still concerns about the benefit risk profile of these medication. Against this background, the naturopathic medicine of this population group could serve well by creating a more comprehensive plan for the treatment of mental health.

In older patients there may be the greatest risk that they will not respond to the initial medication and seem to have a greater risk of another depression as soon as remission is achieved. In view of this information about undesirable events and the fact that older patients are exposed to a higher risk of a new illness, we, as naturopathic doctors, must try to offer our patients natural treatment recommendations that have clear advantages for healing the underlying pathology of a depressive disease. For example, it is known that hippocampus atrophy is a signature of depression and cognitive decay. A study with 120 older adults with dementia showed that subjects showed an increased hippocampus volume (by 2 %) for 3 days a week a week a week a week a week aerobic exercises and this activity effectively reversed any age-related loss of the brain volume. The expected brain loss was observed in control persons who did not carry out aerobics exercises, but instead only carried out stretching and muscle training.

Even with the medication that is considered a "safer" one for seniors, there are still concerns about the benefit risk profile of these medication.

also simple lifestyle supplements can be worth. In a 10-year cohort study with more than 50,000 older women, researchers found that those who drank 2 to 3 cups a day, compared to those who drank 1 cup or less caffeinated coffee a week, had a 15 % lower risk of depression, and those who drank 4 cups or more had a 20 % lower risk. For older people who tend to depression, the daily intake of caffeinated coffee can be useful. ^{7 Other studies have found this hormonal support 8 was helpful for treatment -resistant depressive older women and in the treatment of lead exposure 9 can improve cognitive function.}

Non-pharmacological nutritional supplements can also help to avoid the need for medication. MRI studies in depressive geriatric patients showed that imbalances in the prefrontal cortex could be remedied by using acetyl-l carnitin. ^{10 A low-dose fishing oil therapy in 66 older patients (a total of 1,000 mg broken down to around 300 mg EPA and DHA) provided in another double blind, Randomized, placebo -controlled study a clinical benefit and had a much greater effect than placebo. which showed clear differences in the age depression scale after taking disruptive factors such as body mass, thyroid dysfunction and cholesterol.}

restrictions

Although this analysis was strong and helpful, a total of some restrictions are worth mentioning.

first and above all, the examined doses of the antidepressants reflected the lower border (or the lower half) of the recommended area for older adults. Second, none of the studies checked was actually designed to evaluate unwanted events. Thirdly, the evaluations on which these results were based excluded patients with multiple comorbidities or other neuropsychiatric diseases such as dementia or a high risk of suicide. These first 3 restrictions have might have meant that side effects have not been sufficiently reported.

Since only individual randomized controlled studies were available for certain medications, the authors said that they were only able to recognize side effects of BUPROPION, MINTAZAPIN, trazodone or preodoxetine. Therefore, these medication can also give cause for concern.

Since the authors had no data that made it possible for them to evaluate whether the damage differed depending on the patient, we cannot say whether this information is disproportionately on men or women.