Depression in the Elderly
Existing antidepressants are known to influence the functioning of certain neurotransmitters in the brain. The newer medications -- chiefly the selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) -- are generally preferred over the older medications, including tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) because they have fewer and less severe potential side effects. Both generations of medications are effective at relieving depression; however, some people will respond to one type of drug, but not another. Some examples of newer depression medications include:
- Citalopram (Celexa®)
- Escitalopram (Lexapro®)
- Fluvoxamine (Luvox®)
- Paroxetine (Paxil®)
- Sertraline (Zoloft®)
- Duloxetine (Cymbalta®)
- Venlafaxine (Effexor®, Effexor XR®).
With all types of antidepressants, people must take regular doses for at least three to four weeks, and sometimes longer, before they are likely to feel the full benefit. They should continue taking the medication for an amount of time specified by their doctor -- even if they are feeling better -- to keep the depression from returning.
Stopping depression medication should be done only under a doctor's supervision. Some medications need to be stopped gradually to give the body time to adjust. Although they are not habit-forming or addictive, antidepressants should not be stopped abruptly. Doing so can cause withdrawal symptoms or lead to a relapse. Some people, such as those whose depression is chronic or keeps returning, may need to stay on the medication for a long time.
Older adults who are experiencing their first episode of depression also may want to stay on antidepressant medication for a while, even if their symptoms have disappeared. Recent research shows that people age 70 and older who took antidepressant medication for two years after they became symptom-free were 60 percent less likely to experience a relapse than those who stopped taking the medication.
For older adults who are already taking several medications for other conditions, it is important to talk with a doctor about any adverse drug interactions that may occur while taking antidepressants.
In rare cases, antidepressant medications, especially SSRIs, may lead to suicidal thoughts or actions. However, there is no evidence that they may have this unintended effect among older adults.