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OtherPractice

Antidepressants in the elderly

Adrienne J. Lindblad, Jo-Anne Clarke and Shan Lu
Canadian Family Physician May 2019, 65 (5) 340;
Adrienne J. Lindblad
Knowledge Translation and Evidence Coordinator for the Alberta College of Family Physicians and Associate Clinical Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
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Jo-Anne Clarke
Geriatrician and Medical Lead at North East Specialized Geriatric Centre at Health Sciences North in Sudbury, Ont.
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Shan Lu
Family physician with additional training in care of the elderly practising in Edmonton.
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Clinical question

How effective are antidepressants for treating depression in the elderly?

Bottom line

Response to antidepressants in the elderly varies widely from 45% to 80%, compared with 35% to 70% for placebo, with inconsistencies in part owing to use of secondary analysis, variable age cutoffs, and short trials. Efficacy might decrease with patient age. Harms of antidepressants are common, with approximately 20% of patients stopping owing to adverse effects.

Evidence

Five recent systematic reviews of RCTs used different ages for inclusion.

  • For all antidepressants1 (mean age about 70, mostly followed for 4 [range 3 to 20] weeks), there were statistically different rates of “recovery” (achieving a set change in or reaching a predetermined depression score).

    • -Tricyclic antidepressants (TCAs) in 10 RCTs: 75% versus 51% (placebo), number needed to treat of 5.

    • -Selective serotonin reuptake inhibitors (SSRIs) in 2 RCTs: 83% versus 72% (placebo), number needed to treat of 10.

  • For SSRIs and newer antidepressants only2 (10 RCTs, mean ages 68 to 80, followed for 6 to 12 weeks), there were statistically different rates of response, defined as a 50% or more improvement in symptoms, (44% vs 35% [placebo]) and “remission” (33% vs 27%), although results were inconsistent.

  • For any antidepressant3 (15 RCTs, mean follow-up of about 7 weeks), response (> 50% improvement in symptoms) decreased with age: 54% for mean age 44, 45% for mean age 70, 42% for mean age 73.

    • -Placebo response rates were similar regardless of age (about 33% to 39%).

    • -Post hoc analysis found no difference from placebo when limited to studies of those older than 65.

  • For SSRIs only4 (12 RCTs, mean ages 70 to 79, followed for mostly 8 weeks), there was no difference in remission or response versus placebo.

Context

  • There is likely no difference in efficacy between TCAs and SSRIs, but withdrawals from treatment owing to adverse effects are higher with TCAs (24% vs 17%).5

  • Elderly patients might respond to antidepressants more slowly than younger adults, possibly requiring 10 to 12 weeks before effects are seen.2

  • Chronic illness often coexists with depression in elderly patients, along with frailty, possibly mitigating effects.6

  • In the elderly, antidepressants have been associated with a fall risk similar to that with benzodiazepines.7

  • Antidepressants might not be effective in treating depression in dementia.8

Implementation

Late-life depression affects 15% to 20% of people older than 65 and is associated with reduced quality of life and function, and increased risk of death.9 When starting antidepressants, setting goals can help determine response in a practical way (eg, improved socialization, sleep, anxiety, appetite, energy). Medical conditions and their symptoms should be optimized, pain treated, and strategies employed to improve socialization. In patients with dementia, apathy is common (50% to 90%) and can often be misconstrued as depression.10 Interventions such as cognitive-behavioural therapy and exercise have been inconsistently shown to improve depressive symptoms.11,12

Notes

Tools for Practice articles in Canadian Family Physician are adapted from articles published on the Alberta College of Family Physicians (ACFP) website, summarizing medical evidence with a focus on topical issues and practice-modifying information. The ACFP summaries and the series in Canadian Family Physician are coordinated by Dr G. Michael Allan, and the summaries are co-authored by at least 1 practising family physician and are peer reviewed. Feedback is welcome and can be sent to toolsforpractice{at}cfpc.ca. Archived articles are available on the ACFP website: www.acfp.ca.

Footnotes

  • Competing interests

    None declared

  • The opinions expressed in Tools for Practice articles are those of the authors and do not necessarily mirror the perspective and policy of the Alberta College of Family Physicians.

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Wilson K,
    2. Mottram PG,
    3. Sivanranthan A,
    4. Nightingale A
    . Antidepressant versus placebo for depressed elderly. Cochrane Database Syst Rev 2001;(1):CD000561.
  2. 2.↵
    1. Nelson JC,
    2. Delucchi K,
    3. Schneider LS
    . Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence. Am J Geriatr Psychiatry 2008;16(7):558-67.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Tedeschini E,
    2. Levkovitz Y,
    3. Iovieno N,
    4. Ameral VE,
    5. Nelson JC,
    6. Papakostas GI
    . Efficacy of antidepressants for late-life depression: a meta-analysis and meta-regression of placebo-controlled randomized trials. J Clin Psychiatry 2011;72(12):1660-8.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Tham A,
    2. Jonsson U,
    3. Andersson G,
    4. Söderlund A,
    5. Allard P,
    6. Bertilsson G
    . Efficacy and tolerability of antidepressants in people aged 65 years or older with major depressive disorder. A systematic review and a meta-analysis. J Affect Disord 2016;205:1-12. Epub 2016 Jun 18.
    OpenUrl
  5. 5.↵
    1. Mottram PG,
    2. Wilson K,
    3. Strobl JJ
    . Antidepressants for depressed elderly. Cochrane Database Syst Rev 2006;(1):CD003491.
  6. 6.↵
    1. Vaughan L,
    2. Corbin AL,
    3. Goveas JS
    . Depression and frailty in later life: a systematic review. Clin Interv Aging 2015;10:1947-58.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Woolcott JC,
    2. Richardson KJ,
    3. Wiens MO,
    4. Patel B,
    5. Marin J,
    6. Khan KM,
    7. et al
    . Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009;169(21):1952-60.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Dudas R,
    2. Malouf R,
    3. McCleery J,
    4. Dening T
    . Antidepressants for treating depression in dementia. Cochrane Database Syst Rev 2018;(8):CD003944.
  9. 9.↵
    1. Buchanan D,
    2. Tourigny-Rivard MF,
    3. Cappeliez P,
    4. Frank C,
    5. Janikowski P,
    6. Spanjevic L,
    7. et al
    . National guidelines for seniors’ mental health: the assessment and treatment of depression. Can J Geriatr 2006;9(Suppl 2):S52-8.
    OpenUrl
  10. 10.↵
    1. Lanctôt KL,
    2. Agüera-Ortiz L,
    3. Brodaty H,
    4. Francis PT,
    5. Geda YE,
    6. Ismail Z,
    7. et al
    . Apathy associated with neurocognitive disorders: recent progress and future directions. Alzheimers Dement 2017;13(1):84-100.
    OpenUrl
  11. 11.↵
    1. Jonsson U,
    2. Bertilsson G,
    3. Allard P,
    4. Gyllensvärd H,
    5. Söderlund A,
    6. Tham A,
    7. et al
    . Psychological treatment of depression in people aged 65 years and over: a systematic review of efficacy, safety and cost-effectiveness. PloS One 2016;11(8):e0160859.
    OpenUrlCrossRef
  12. 12.↵
    1. Dhawan S,
    2. Klein D,
    3. Lindblad AJ
    . Working out depression: is exercise effective for depression? Edmonton, AB: Tools for Practice; 2015. Available from: https://gomainpro.ca/wp-content/uploads/tools-for-practice/1421685837_130exerciseanddepression.pdf. Accessed 2019 Mar 4.
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Canadian Family Physician: 65 (5)
Canadian Family Physician
Vol. 65, Issue 5
1 May 2019
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Antidepressants in the elderly
Adrienne J. Lindblad, Jo-Anne Clarke, Shan Lu
Canadian Family Physician May 2019, 65 (5) 340;

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Adrienne J. Lindblad, Jo-Anne Clarke, Shan Lu
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