The selective serotonin reuptake inhibitors (SSRIs) and the newer antidepressants buproprion, mirtazapine , moclobemide, and venlafaxine (a selective norepinephrine reuptake inhibitor or SNRI) are all relatively safe in the elderly .
Conclusions: Limited evidence suggests that for certain elderly patients, mirtazapine may be preferable to sertraline for treatment of depression. It may also be more cost-effective in patients who have dementia.
Serious side effects thoughts about harming yourself or ending your life. constant headaches , long-lasting confusion or weakness, or frequent muscle cramps – these can be signs of low sodium levels in your blood (which can cause seizures in severe cases)
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.
To date, there are no known problems associated with long term use of mirtazapine. It is a safe and effective medication when used as directed.
However, elderly patients are more likely to have confusion or unusual drowsiness and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving mirtazapine .
Precautions – while taking mirtazapine It can also cause agitation, aggression and forgetfulness. If you do drink alcohol, drink only small amounts and see how you feel. Do not stop taking your medication. If you have a fever, sore throat or sore mouth while taking mirtazapine , let your doctor know immediately.
The pivotal original studies supported an FDA-approved antidepressant indication for mirtazapine 15–45 mg /d. While the drug is commonly used off-label at lower doses ( 7.5 to 15 mg at bedtime) primarily for a soporific effect, antidepressant effects at doses of 7.5 mg /d have been reported.
Antidepressants such as sertraline, citalopram, mirtazapine and trazodone are widely prescribed for people with dementia who develop depression. Some recent trials have shown that common antidepressants do not work well in this group, but they may still be tried.
Symptoms can include: headache. feeling unsteady or weak. confusion, trouble concentrating or thinking, or memory problems .
Remeron is an alpha-2 receptor blocker, an antidepressant that is sometimes administered to people — emaciated folks — who need to gain weight . One set of studies indicated that most patients gain weight on Remeron after the first four weeks of treatment.
Mirtazapine ( Remeron ) has a much more sedating effect, generally reducing its potential to aggravate initial anxiety .
Buspirone is an anti-anxiety drug that has been shown to be effective for older adults. Benzodiazepines , another anti-anxiety drug, are effective but should be prescribed carefully to older adults because of risk of memory impairment, unsteadiness, and falls.
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.
Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly prescribed medications with low risk adverse events.