Summary:
Age represents an important factor influencing general principles of the pharmacotherapy and
prophylaxis in late - life depression. Ageing may accentuate some clinical features and course of
depression and may also increase the susceptibility to some side effects, e.g. extrapyramidal,
cardiovascular or cognitive. Old patients and/or patients with serious physical disorders were
often not included into clinical trials, so there are only limited data of EBM (Evidence Based
Medicine) category.
We present a recent review concerning clinical manifestation and pharmacotherapy of late-life
depression. Summary of published studies is illustrated by our clinical data. Summary of evidence:
depression developed in old age has a more complex aetiology, weight loss, anxiety and poor
subjective memory or a dementia-like picture are common symptoms. Changes in cognitive or
event-related brain potential (P300) have been well established as a sensitive measure of cognitive
dysfunction. It can be used to differentiate cognitive disturbances related to depression from
those caused by organic brain disease. Safety and tolerability are most important parameters for
the choise of an antidepressant. Antidepressants with a selective mechanism of action are more
safe in the terms of treatment-related intensity and profile of side effects. Citalopram and sertraline
have well documented evidence of safety in the treatment of late - life depression with somatic
comorbidity. Antidepressants with dual effect, e.g. venlafaxine and mirtazapine may also have
effectivity and tolerability advantages in this indication.
Key words:
depression. old age, antidepressants, safety of pharmacotherapy.
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