ABSTRACT
Elderly patients, just as younger ones, may suffer from the two extremes of affective disturbance known as mania and depression. Either may be secondary to underlying organic causes often requiring specific treatment. For primary disorders, treatment typically consists of pharmacotherapy and/or psychotherapy. Pharmacologic treatment of nonorganic conditions is essentially similar to that used in younger patients, although medication dosages are generally lower and side effects more common.
Subject(s)
Affective Disorders, Psychotic , Adult , Affective Disorders, Psychotic/diagnosis , Affective Disorders, Psychotic/drug therapy , Affective Disorders, Psychotic/epidemiology , Aged , Female , Humans , Male , Middle Aged , United StatesABSTRACT
Fear of possible cardiovascular side effects has prevented many physicians from treating older patients with antidepressants. However, we believe that it is the rare patient who cannot or should not be treated with some agent. Start with a low dose of desipramine, doxepin, or trazodone, depending upon the tolerance for sedation and anticholinergic side effects. Barring specific contraindications, the choice of drugs is usually based on the side-effect profile, rather than any differences in efficacy.
Subject(s)
Depressive Disorder/drug therapy , Aged , Antidepressive Agents/administration & dosage , Antidepressive Agents/adverse effects , Antidepressive Agents/therapeutic use , Arrhythmias, Cardiac/chemically induced , Cardiovascular Diseases/chemically induced , Depressive Disorder/diagnosis , Humans , Middle AgedABSTRACT
Blood pressure measurements were collected from 36 depressed geriatric outpatients (ages 55 to 81 years) enrolled in a double-blind, placebo-controlled study of the efficacy of doxepin and imipramine. Mean systolic postural changes were 25.9 mm Hg for imipramine, significantly higher than the 10.5 mm Hg for doxepin, and 12.4 mm Hg for placebo. The orthostatic drop in the imipramine group was only weakly related to dose and did not correlate with amount of pretreatment orthostatic hypotension or with duration of treatment. The increased orthostatic hypotension occurred early in treatment and at low doses of imipramine. Accordingly, caution is advised in the use of imipramine for the elderly.
Subject(s)
Depressive Disorder/drug therapy , Doxepin/adverse effects , Hypotension, Orthostatic/chemically induced , Imipramine/adverse effects , Age Factors , Aged , Double-Blind Method , Female , Humans , Male , Middle AgedABSTRACT
The Scientific Board of the California Medical Association presents the following inventory of items of progress in psychiatry. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, research workers or scholars to stay abreast of these items of progress in psychiatry that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Psychiatry of the California Medical Association and the summaries were prepared under its direction.
ABSTRACT
The geriatric patient has a high incidence of cardiovascular and psychiatric illness; treatment of either may lead to emergence or aggravation of the other. Toxic side effects can frequently be managed by a reduction in dose or a change in medication. In general, the psychiatric problems of elderly patients, including patients with cardiovascular disease, can be managed despite the cardiovascular toxicity of most psychotropic drugs. Psychiatrists who treat geriatric patients need an understanding of psychopharmacology and clinical manifestations of the cardiovascular system in order to provide well-rounded care.
