SSRIs considered to have the best safety profile in the elderly are citalopram, escitalopram, and sertraline.
When it comes to antidepressants for seniors, most experts recommend SSRIs or selective norepinephrine reuptake inhibitors (SNRIs), which help increase the brain chemicals serotonin and norepinephrine.
Sertraline is generally well tolerated in elderly patients with major depressive disorder and lacks the marked anticholinergic effects that characterise the adverse event profiles of tricyclic antidepressants (TCAs).
Overall, citalopram appears to be the best-tolerated SSRI, followed by fluoxetine , sertraline , paroxetine , and fluvoxamine. The latter 2 drugs are associated with the most side effects and the highest discontinuation rates because of side effects in clinical trials.
March 28, 2012 — The selective serotonin reuptake inhibitor (SSRI) citalopram ( Celexa , Forest Laboratories) should not be used at doses greater than 20 mg per day in adults older than 60 years because of a potential risk for QT prolongation, the FDA warns.
Tricyclic antidepressants , especially amitriptyline and dothiepin ,16 are known to pose a high risk of death in overdosage. These drugs should therefore be avoided in older people whose medication is not supervised and who are at risk of taking an overdose.
When talking with an older adult who has an anxiety problem: Be calm and reassuring. Acknowledge their fears but do not play along with them. Be supportive without supporting their anxiety . Encourage them to engage in social activities. Offer assistance in getting them help from a physician or mental health professional.
With the exception of paroxetine, the long-term use of most antidepressants does not increase dementia risk, suggests a study published in the Journal of the American Geriatrics Society.
Short-half-life benzodiazepines, such as oxazepam , alprazolam , and triazolam , are usually recommended for older adults, because these agents do not accumulate in the blood, are rapidly cleared from circulation, and offer greater dosage flexibility.
Options include citalopram ( Celexa ), fluoxetine ( Prozac ), nortriptyline (Pamelor), paroxetine ( Paxil ), and sertraline ( Zoloft ). Side effects of these medicines can include drowsiness, dry mouth, constipation, and anxiety.
Antidepressants sold in the United States that the study found to be most effective included: Amitriptyline . When the researchers checked which depression drugs were tolerated the best, these topped the list: Celexa ( citalopram ) Lexapro ( escitalopram ) Prozac ( fluoxetine ) Trintellix ( vortioxetine ) Zoloft ( sertraline )
The antidepressants most widely prescribed for anxiety are SSRIs such as Prozac , Zoloft , Paxil , Lexapro , and Celexa .
Selective serotonin reuptake inhibitors ( SSRI ) such as Prozac are regularly used to treat severe anxiety and depression. They work by immediately increasing the amount of serotonin in the brain and by causing long term changes in brain function.
New research links certain medications to dementia risk amitriptyline , paroxetine, and bupropion (most commonly taken for depression) oxybutynin and tolterodine (taken for an overactive bladder) diphenhydramine (a common antihistamine, as found in Benadryl ).
Another study published last year from researchers in Taiwan also linked SSRIs with an increased risk of dementia . However, a U.S. team reported two years ago the SSRI citalopram (sold under the brand name Celexa ) appeared to reduce production of the deadly brain plaques tied to Alzheimer’s.
Conclusions: Duloxetine improved cognition, depression, and some pain measures and was safe and well tolerated in elderly patients with recurrent major depressive disorder. Major depressive disorder is a common disorder in the elderly and is often associated with physical disability and cognitive deficits (1 , 2) .