Use of atypical antidepressants in elderly patients

Late-life major depressive disorder (MDD) is a common disorder that is associated with severe symptoms and substantial functional impairment. With an estimated prevalence of 3% in people aged 60 years or more, MDD has growing health implications for the aging population. In addition, MDD is often associated with physical disability in this age group as well as a high mortality rate. Conditions leading to chronic pain, the presence of comorbid medical illnesses, social isolation, and dysphoria secondary to life-cycle issues predispose the elderly population to the development of depression. These factors also point elderly individuals with depression in the direction of more severe symptoms and a relatively poor outcome.
While it is a commonly known psychiatric disorder, depression in the geriatric population is under-recognized and under-treated, leading to unnecessary impaired social and occupational functioning.1 Studies suggest that approximately 25% of patients aged 65 years or more who have a chronic medical illness also experience symptoms of depression. Evidence supports the increased prevalence of depression in several specific chronic medical illnesses, including vascular disease, diabetes mellitus, and arthritis; the relative risk for depression is 2-3 times higher in these patients than in individuals without these comorbidities.1 Depression in the geriatric population has also been reported to be more somatic and less ideational than depression in younger adults. Elderly people who suffer from comorbid depression and medical illness have an increased morbidity and mortality.1 Authors have also noted a brittle response to antidepressant therapy and an increased risk for chronic depression in the elderly population.2 Safe, effective, well-tolerated antidepressants are needed for elderly patients with MDD, especially for those who are also struggling with chronic medical illness.1

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