Antidepressants for depressed elderly
Sübutlu məlumatların xülasələri
26.04.2018 • Sonuncu dəyişiklik 26.04.2018
Editors
Tricyclic antidepressants and selective serotonin reuptake inhibitors are equally efficacious in the treatment of depression in older people and they have similar withdrawal rates.
A Cochrane review included 29 studies. No differences in efficacy when comparing classes of antidepressants were found. Tricyclic antidepressants (TCAs) compared less favourably with selective serotonin reuptake inhibitors (SSRIs) in terms of numbers of patients withdrawn irrespective of reason (RR 1.24; 95% CI 1.04 to 1.47) and number withdrawn due to side effects (RR 1.30; 95% CI 1.02 to 1.64). Subgroup analyses demonstrated that TCA related antidepressants had similar withdrawal rates to SSRIs irrespective of reason of withdrawal (RR 1.49; 95% CI 0.74 to 2.98) or withdrawal due to side effects (RR 1.07; 95% CI 0.43 to 2.70). A small increased profile of gastro-intestinal and neuropsychiatric side effects associated with classical TCAs was found in qualitative analysis.
Another Cochrane review (abstract ,"?> included 17 studies with a total of 1 326 subjects. Only comparisons to placebo were included. All studied antidepressants were effective in the treatment of depression in elderly, the standardised effect sizes for three groups of antidepressants were: TCAs; OR 0.32 (95% CI 0.21 to 0.47), SSRIs; OR 0.51 (95% CI 0.36 to 0.72), MAOIs; 0.17 (95% CI 0.07 to 0.39). The adverse effects were not reported in the review. The authors conclude that antidepressants (TCAs, SSRIs and MAOIs) are effective in the treatment of depression in elderly as compared
with placebo.
A systematic review
including 6 studies with a total of 416 subjects in the SSRI group and 307 in the tricyclic antidepressant (TCA) comparison group was abstracted in DARE. No significant difference between SSRI and TCS was found in any of the studies. Total drop-outs were 40.7% in the SSRI group and 50% in the TCA group (OR 0.67, 95% CI 0.47 to 0.97). Drop-outs due to side effects were 24.5% in the SSRI group and 31.7% in the TCA group. Side effects were reported in 76.2% in the SSRI group and 86.6% in the TCA group (OR 0.34,
95% CI 0.15 to 0.76)
Another systematic review
including 64 studies with a total of 6 ,029 subjects (of all ages) was abstracted in DARE. More patients taking tricyclic antidepressants dropped out than patient taking selective serotonin reuptake inhibitors, both overall and because of side effects. The pooled risk ratios indicated a 10% reduction in total drop outs (95% CI 3% to 16%) and a 25% reduction in drop outs due to side effects (16% to 34%) when SSRIs were used. This means that 30 of every 100 patients taking tricyclics will drop out versus 27 of every 100 taking SSRIs.
Another systematic review
on depressed elderly (aged 60 year or older) abstracted in DARE included 16 studies on efficacy, 39 studies on tolerability and 63 studies on dropout rates. There were no significant differences with respect to efficacy and tolerability (adverse effects and drop out rates) for four antidepressant classes (tricyclic, SSRIs, MAO inhibitors and atypical antidepressants).
Ədəbiyyat
- Mottram P, Wilson K, Strobl J. Antidepressants for depressed elderly. Cochrane Database Syst Rev 2006 Jan 25;(1):CD003491.
- Wilson K, Mottram P, Sivanranthan A, Nightingale A. Antidepressant versus placebo for depressed elderly. Cochrane Database Syst Rev 2001;(2):CD000561.
Menting JE, Honig A, Verhey FR, Hartmans M, Rozendaal N, de Vet HC, van Praag HM. Selective serotonin reuptake inhibitors (SSRIs) in the treatment of elderly depressed patients: a qualitative analysis of the literature on their efficacy and side-effects. Int Clin Psychopharmacol 1996 Sep;11(3):165-75.
Anderson IM, Tomenson BM. Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis. BMJ 1995 Jun 3;310(6992):1433-8.
Mittmann N, Herrmann N, Einarson TR, Busto UE, Lanctôt KL, Liu BA, Shulman KI, Silver IL, Narango CA, Shear NH. The efficacy, safety and tolerability of antidepressants in late life depression: a meta-analysis. J Affect Disord 1997 Dec;46(3):191-217.