Three-part series to better understand antidepressant medications
Part 1
Winter is a difficult time for people who suffer from depression. Depression can be treated with a variety of interventions ranging from psychotherapy to medications. Older persons also are more prone to depression which is usually referred to as late life depression. Many of these individuals take antidepressants which often provide partial or even complete relief from this disorder. However, any medication in the elderly must be taken with caution. Antidepressants are no exception.
We will be discussing the use of antidepressants in the elderly in order to provide a straightforward overview of these medications including both their positive and negative effects.
Before we begin to talk about antidepressants, we need to address some basic facts regarding medications in the elderly. All medications need to be prescribed and monitored carefully as the elderly are more at risk to develop complications from medications, including medications as simple as aspirin.
The first factor affecting the elderly is the aging body. The intestinal motility and the absorption of drugs are slower as one gets older. This usually means that the drugs take longer to act because they are not able to get into the body as quickly as you would see in a younger person. For example, somebody taking sleeping pills may need to take them an hour or two before bedtime, because it takes that long for them to have the desired effect.
As one gets older medications are slower to be removed from the body through the liver or kidneys. As a result medication levels can be much higher in the blood as well as other organs of the body. This is why a physician may not prescribe the usual dose of medication because a smaller dose produces the same therapeutic effect in the elderly. A traditional dose of the medication may actually provide too much medication for the older person and can cause serious complications. We will talk more about these complications in later parts of the series.
The second element affecting the older person is the number of medications they typically use. The more medications taken, the more interactions and complications occur. Physicians expert in the area of geriatrics understand this concept and often reduce or eliminate certain medications instead of adding new ones in order to avoid such complications.
The final dynamic sometimes seen in the elderly is their use of medications in a way that is not what the doctor ordered. Borrowing a friend’s medications or adjusting the dose of medications without consulting their physician are two examples of behaviors that can get the elderly person into trouble. In the case of an antidepressant, the positive effect may not be seen for a month or two after it was started. Some patients will increase the dose prematurely with the false premise that this will make the drug work faster. This, however, can be a dangerous proposition. The bottom line is that you need to discuss your medications thoroughly with your physician and take them exactly as prescribed.
Now that you understand the basics, the next two parts in the series will discuss choosing the right antidepressant and monitoring potential complications.
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