Essentials of Clinical Geriatrics, 7e >Chapter 7.

Diagnosis and Management of Depression

Robert L. Kane, Joseph G. Ouslander, Itamar B. Abrass, Barbara Resnick+
Table 7–13. Antidepressants for Geriatric Patients

Drug group generic name (brand name) Drug group side effects Special concerns with older adults

Tricyclic antidepressants

Dry mouth
Amitriptyline (Elavil)
Blurred vision
Amoxapine (Asendin)
Clomipramine (Anafranil) Constipation
Desipramine (Norpramin or Pertofrane) Difficulty urinating
Doxepin (Sinequan or Adapin) Increased heart rate These drugs are best avoided because of the side effects
Imipramine (Tofranil) Loss of sex drive and erectile failure Amoxapine can cause extrapyramidal effects
Maprotiline (Ludiomil) Increased sensitivity to the sun
Nortriptyline (Pamelor or Aventyl) Weight gain
Protriptyline (Vivactil)
Drowsiness
Trimipramine (Surmontil)
Dizziness and nausea

MAOIs

Light-headedness upon standing

Dizziness
Phenelzine (Nardil) Insomnia
All foods and drinks containing tyramine must be avoided, or the
Tranylcypromine (Parnate) Weight gain
patient may experience a hypertensive crisis, stroke, or myocardial
Isocarboxazid (Marplan) Headaches
Selegiline (Emsam) infarction
Insomnia
Sexual problems such as impotence
Sleepiness

SSRIs

Nausea
Insomnia
Anxiety and restlessness SSRIs can cause an increase in suicidal thoughts and behaviors
Decreased sex drive SSRIs also carry a risk for increased hostility, agitation, and
Fluoxetine (Prozac)
Fluvoxamine (Luvox) Dizziness anxiety
Sertraline (Zoloft) Weight gain or weight loss SSRIs should not be taken at the same time as MAOIs
Paroxetine (Paxil) Tremors Taking an SSRI within 2 weeks of an MAOI can cause a fatal
Escitalopram (Lexapro) Sweating reaction
Citalopram (Celexa) Drowsiness or fatigue In adults 65 and older, SSRIs increase the risk for falls, fractures,
Duloxetine (Cymbalta) Dry mouth and bone loss
Mirtazapine (Remeron)
Diarrhea or constipation Mirtazapine causes significant sedation and weight gain so is
Headaches effective for those with sleep disorders and weight loss
Nausea
Nervousness

Atypical antidepressants

Sexual dysfunction
Bupropion (Wellbutrin) Dry mouth Venlafaxine should not be used in those with hypertension
Trazodone (Desyrel) Fatigue Duloxetine may be effective in those suffering from both
Venlafaxine (Effexor) Sleepiness depression and pain
Nefazodone (Serzone) Weight gain Nefazodone may cause hepatotoxicity
Blurred vision

MAOIs, monoamine oxidase inhibitors; SSRIs, selective serotonin reuptake inhibitors.

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