מתוך medicontext.co.il
By Karla Gale
WESTPORT, CT (Reuters Health) – A survey of experts in the field of geriatric psychiatry, aimed at developing a set of Expert Consensus Guidelines on pharmacotherapy for depression in older patients, indicates that selective serotonin reuptake inhibitors (SSRIs) are the "medications of choice" in this setting.
Dr. George S. Alexopoulos, of Weill Medical College of Cornell University in Ithaca, New York, identified and sent questionnaires to 50 leading American experts in the field of geriatric depression, based on their national clinical and academic reputations. As reported in a Postgraduate Medicine Special Report for October, all those contacted completed and returned the surveys.
The surveys were designed to answer "important clinical questions that had not yet been adequately addressed or definitely answered in the literature." It included 64 questions with 857 options. For 618 of the options, the raters evaluated responses on a 9-point scale, where 1 would represent extremely inappropriate and 9 would represent extremely appropriate.
Of these latter 618 options, consensus was reached on 553 (89%). First-line treatments were strategies that rated 6.5 or above. Treatments of choice were rated as "9" by at least half of the respondents.
SSRIs and venlafaxine XR were considered medications of choice. Most of those polled would not use amitriptyline, amoxapine, doxepin, imipramine, isocarboxazid, maprotiline, tranylcypromine, or trazodone in older patients.
For situations in which medical comorbidity contributes to depression, the experts recommend adding an antidepressant to treatment of the medical condition if the condition is not likely to respond promptly to treatment. If a medication is a likely contributor to depression, most of the time the psychiatrists would recommend switching to another medication.
"Often it is best to switch to another class of antihypertensives or drugs used to treat cardiac arrhythmia or emphysema," Dr. Melinda Lantz, director of psychiatry at the Jewish Home and Hospital in York, told Reuters Health. "This is a good age in that there are alternatives for most treatments, so in the majority of cases, the physician can switch the patient."
Dr. Lantz's only quibble with the new guidelines, she said, is their failure to adequately address psychosocial interventions and their lack of emphasis on recognizing risk factors for suicide in this high-risk population.
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