Choosing the best antidepressants for teenagers and seniorsRuslan Dorfman, PhD, MBA
Depression can affect both the young and old. Younger age group studies of depression show stress and social pressures from peers and parents alike can cause depression. However, rates of depression increase with age. Work-related stress, unsuccessful marriages, or the loss of a spouse are the leading causes of depression in older people. Antidepressants along with counselling can help manage symptoms of depression. Antidepressant selection should be adjusted for age to address the risk of age-related side effects. In other words, the best choice of antidepressants for young people may be not suitable for seniors.
Several types of antidepressants, such as duloxentine, are known to increase the risk of suicide and should not be used for pediatric patients. Ariprazole and other antipsychotic drugs are known to increase the risk of death in elderly patients with dementia-related psychosis. The dosing of tricyclic antidepressants (TCAs) and antipsychotics is affected by age, weight, liver, and kidney functions. Genetic variations in the CYP2D6 and CYP2C19 enzymes also influence dosing, as these enzymes handle metabolizing these drugs. Most TCAs, SSRIs, and SNRIs should not be used in those who are either Poor or Ultrarapid Metabolizers for CYP2D6 or CYP2C19 due to an elevated risk of side effects and abnormal response.
TCAs and SNRIs are also commonly used to manage chronic pain. SNRIs such as venlafaxine are known to raise blood pressure, which can be more severe in the elderly. Therefore, these drugs should not be used in older people with hypertension.
The use of antidepressants with other drugs, such as pregabalin, can cause sleepiness, dizziness, and falls. An increased incidence of fractures has been seen in elderly patients treated with pregabalin. In addition to falls, decreased respiratory drive can lead to sudden death, especially in older people with sleep apnea.
Benzodiazepines are also known to cause more severe side effects in the elderly. Auto accidents also become more frequent when using benzodiazepines. Negative side effects of benzo diazepines are amplified due to an age-related decrease in drug clearance. This is also affected by variations in the cytochrome P450 genes. SSRI use can also lead to an impairment in gait, which is also known as a postural sway problem. This impairment occurs much more often in the elderly than in younger people.
Gastrointestinal bleeding is also a concern for all age groups using SSRIs. However, this is worse in the elderly, mainly due to their increased use of ibuprofen and other NSAIDs for pain. SSRIs can also cause bone loss and low sodium levels in the elderly.
An age-related decrease in the clearance of citalopram, escitalopram, quetiapine, deutetrabenazine and many other commonly used antidepressants increases the risk of QTc interval prolongation. This side effect can lead to sudden heart failure in elderly patients.
Pharmacogenetic testing can help patients and physicians select safer drugs and the proper antidepressant dose to reduce risk for both the elderly and the young. Pillcheck can help you and your loved ones find the right treatment for depression and chronic pain. Pillcheck includes a medication review by clinical pharmacist who can advise your physician how to adjust treatment according to your age, and drug metabolic profile.