Antidepressants in the Geriatric Population Evaluation of side effects is considered the most important parameter guiding the selection of antidepressants in the geriatric population. The older tricyclic antidepressants, although highly effective, are notorious for a range of side effects. The most reported side effects include excessive sedation, anticholinergic effects (dry mouth, constipation, urinary retention, blurred near vision, tachycardia, and confusion), orthostatic hypotension, and electrocardiographic changes. Desipramine and nortriptyline cause less severe anticholinergic effects and orthostatic hypotension. Fluoxetine has a long half-life, and its side effects persist for a long time after discontinuation. It is generally not recommended in the geriatric population. Table 7 summarizes psychotropic antidepressant recommendations in the geriatric population. Table 8 summarizes short- and long-acting drugs. Table 7: Psychotropic Antidepressant Recommendations Drugs Geriatric Dosage (mg per day) Side Effects
Starting Dosage
Maintenance Dosage
Sedation
Agitation
Anticholinergic Effects
Orthostatic Hypotension
Tricyclic Antidepressants Desipramine (Norpramin) 25
50 to 150
Low
Low
Low
Low
10 to 25 40 to 75
Moderate
—
Low
Nortriptyline (Pamelor)
Low
Selective Serotonin Reuptake Inhibitors Citalopram (Celexa) 20 20 to 40
Low
Low
—
—
Fluvoxamine (Luvox)
50
50 to 200
Low
Low
—
—
Paroxetine (Paxil)
10
20 to 30
Low
Low
—
—
Sertraline (Zoloft) Miscellaneous Bupropion (Wellbutrin)
25 to 50 50 to 150
Low
Low
—
—
100
100 to 400
—
Moderate
—
Low
Nefazodone (Serzone)
100
100 to 600
Moderate
—
Low
Low
Trazodone (Desyrel) 25 to 50 50 to 300
High
—
Low
Moderate
Venlafaxine (Effexor)
75
75 to 350
Low
Low
Low
Low
Table 8: Short- and Long-Acting Drugs Short-Acting Agents - Benzodiazepines Alprazolam (Xanax)
0.75
0.25
Intermediate
Estazolam (Prosom)
0.5
0.5
Fast
Lorazepam (Ativan)
2
1
Intermediate
Oxazepam (Serax)
30
15
Slow
Temazepam (Restoril)
—
15
Intermediate
Triazolam (Halcion)
—
0.125
Fast
Short-Acting Agents - Antihistamines Diphenhydramine (Benadryl)
50
25
Fast
Hydroxyzine (Atarax)
50
50
Fast
Short-Acting Agents - Miscellaneous Zolpidem (Ambien) Long-Acting Agents - Benzodiazepines
—
5
Fast
Page 182
Book Code: PYFL4024
EliteLearning.com/Psychology
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