Optimizing treatment for older adults with depression
Issued Date
2023-01-01
Resource Type
ISSN
20451253
eISSN
20451261
Scopus ID
2-s2.0-85177031727
Journal Title
Therapeutic Advances in Psychopharmacology
Volume
13
Rights Holder(s)
SCOPUS
Bibliographic Citation
Therapeutic Advances in Psychopharmacology Vol.13 (2023)
Suggested Citation
Srifuengfung M., Bethany R. T.P., Eric J. L. Optimizing treatment for older adults with depression. Therapeutic Advances in Psychopharmacology Vol.13 (2023). doi:10.1177/20451253231212327 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/91212
Title
Optimizing treatment for older adults with depression
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
This review presents a comprehensive guide for optimizing medication management in older adults with depression within an outpatient setting. Medication optimization involves tailoring the antidepressant strategy to the individual, ensuring the administration of appropriate medications at optimal dosages. In the case of older adults, this process necessitates not only adjusting or changing antidepressants but also addressing the concurrent use of inappropriate medications, many of which have cognitive side effects. This review outlines various strategies for medication optimization in late-life depression: (1) Utilizing the full dose range of a medication to maximize therapeutic benefits and strive for remission. (2) Transitioning to alternative classes (such as a serotonin and norepinephrine reuptake inhibitor [SNRI], bupropion, or mirtazapine) when first-line treatment with selective serotonin reuptake inhibitors [SSRIs] proves inadequate. (3) Exploring augmentation strategies like aripiprazole for treatment-resistant depression. (4) Implementing measurement-based care to help adjust treatment. (5) Sustaining an effective antidepressant strategy for at least 1 year following depression remission, with longer durations for recurrent episodes or severe presentations. (6) Safely discontinuing anticholinergic medications and benzodiazepines by employing a tapering method when necessary, coupled with counseling about the benefits of stopping them. Additionally, this article explores favorable medications for depression, as well as alternatives for managing anxiety, insomnia, allergy, overactive bladder, psychosis, and muscle spasm in order to avoid potent anticholinergics and benzodiazepines.