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Antidepressants and elderly

Lone Baandrup, Bjørn H Ebdrup, Jesper Ø Rasmussen, Jane Lindschou, Christian Gluud, Birte Y Glenthøj
BACKGROUND: Prolonged treatment with benzodiazepines is common practice despite clinical recommendations of short-term use. Benzodiazepines are used by approximately 4% of the general population, with increased prevalence in psychiatric populations and the elderly. After long-term use it is often difficult to discontinue benzodiazepines due to psychological and physiological dependence. This review investigated if pharmacological interventions can facilitate benzodiazepine tapering. OBJECTIVES: To assess the benefits and harms of pharmacological interventions to facilitate discontinuation of chronic benzodiazepine use...
March 15, 2018: Cochrane Database of Systematic Reviews
Adriano Roberto Tarifa Vicente, Érico Castro-Costa, Josélia de Oliveira Araújo Firmo, Maria Fernanda Lima-Costa, Antônio Ignácio de Loyola Filho
The purpose of the study was to investigate whether religiousness and social support were associated with the use of antidepressants among community-dwelling elders. The research involved 1,606 older adults who make up the cohort of Bambuí Project, a study on ageing and health. The dependent variable was the use of antidepressants in the last 90 days, and the exposures of interest were social support and religiousness. Logistic regression was used to test the associations and to estimate crude and adjusted Odds Ratio and their 95% confidence intervals...
March 2018: Ciência & Saúde Coletiva
Ji Yeon Lim, Duk Hee Lee
BACKGROUND: Suicide is a significant public health problem worldwide. Suicide rates among elderly persons (≥ 65 years of age) are three times higher than those of younger people in Korea. The emergency department is an important entry of drug-related suicide attempt patients. In this study, we compared the frequency of drug types by age subgroup. Furthermore, we provide suggestions for preventing suicide attempts in the elderly. METHODS: We investigated 433 patients who were admitted to the emergency department for drug-related suicide attempts between 1 May 2015 and 30 April 2017...
March 12, 2018: Journal of Korean Medical Science
Jaśmina Arabska, Anna Łucka, Radosław Magierski, Tomasz Sobów, Adam Wysokiński
Association between inflammation and depression, especially in elderly patients, leads to conclusions about their shared influence on risk of cardiovascular disease and death. It might be found useful to predict those issues by monitoring inflammatory parameters, such as neutrophil/lymphocyte ratio (NLR). The aim of this study was to determine the NLR in elderly patients with unipolar depression compared with non-depressed elderly patients. NLR was measured in 684 Caucasian subjects (depressed: n = 465, non-depressed: n = 219), aged ≥ 60 (depressed: mean age 74...
February 21, 2018: Psychiatry Research
Antonis Goulas, Nikolaos Raikos, Diamantis Krokos, Orthodoxia Mastrogianni, Amvrosios Orphanidis, Konstantinos Zisopoulos, Androniki Tsepa
Serotonin-specific reuptake inhibitors (SSRIs) are generally considered safe drugs but fatal adverse effects do sometimes occur, often as a consequence of interactions with other serotonin active drugs. Polypharmacy is usually a problem that the elderly encounter, but it can also have dire consequences for young people, especially when an underlying heart condition is present. Thus, failure to diagnose heart disease and the use of contraindicated medications can be a lethal combination, irrespective of age...
February 27, 2018: Forensic Science, Medicine, and Pathology
Taeho Greg Rhee, Somaia Mohamed, Robert A Rosenheck
OBJECTIVE: A recent moderately long-term study found an antipsychotic to be more effective than an antidepressant as the next-step treatment of unresponsive major depressive disorder (MDD). It is thus timely to examine recent trends in the pharmacoepidemiology of antipsychotic treatment of MDD. METHODS: Data from the 2006-2015 National Ambulatory Medical Care Survey, nationally representative samples of office-based outpatient visits in adults with MDD (ICD-9-CM codes 296...
February 13, 2018: Journal of Clinical Psychiatry
Gudrun Hefner, Martina Hahn, Matthias Hohner, Sybille C Roll, Ansgar Klimke, Christoph Hiemke
INTRODUCTION: Many antidepressants cause QT prolongation but the classification of cardiac risk of these drugs varies markedly in different published lists. This retrospective study analyzed the correlation of QTc time with amitriptyline and venlafaxine serum level in elderly psychiatric inpatients. METHODS: Elderly inpatients aged≥65 years for whom venlafaxine or amitriptyline serum level had been measured were selected retrospectively from a therapeutic drug monitoring database and screened for an electrocardiogram measurement at the time of blood withdrawal...
February 21, 2018: Pharmacopsychiatry
Iris Zahirovic, Gustav Torisson, Carina Wattmo, Elisabet Londos
BACKGROUND: Elderly persons with a dementia diagnosis often suffer from different neuropsychiatric symptoms (NPS) such as delusions, hallucinations, depression, anxiety, irritability and agitation. Currently, the medical treatment for NPS consists mostly of psychotropic medication such as hypnotics/sedatives, anxiolytics and antipsychotics. In elderly persons with dementia, usage of antipsychotics is less appropriate because of the risk of side effects such as parkinsonism, rapid cognitive decline, cerebrovascular events and finally mortality...
February 17, 2018: BMC Geriatrics
J A H R Claassen
- Orthostatic hypotension is a condition in which there is insufficient recovery of the blood pressure drop which occurs after getting up, which causes a temporary reduction of cerebral perfusion. This increases the risk of falls resulting in injuries.- Orthostatic hypotension is most common in the elderly. The cause is usually multifactorial (including reduced circulating volume, reduced peripheral resistance and limited heart rate increase). Orthostatic hypotension caused by autonomic dysfunction is called neurogenic orthostatic hypotension...
2018: Nederlands Tijdschrift Voor Geneeskunde
Ann L Horgas, Urszula Snigurska, Michelle Z Farland, Michael Marsiske
Objectives: Analyzing medication data for research purposes is complex, and methods are rarely described in the literature. Our objective was to describe methods of quantifying opioid and nonopioid analgesics and to compare the utility of five different analgesic coding methods when analyzing relationships between pain, analgesic use, and clinical outcomes. In this study, we used physical function as the outcome variable for its clinical relevance and its relationship to pain in older adults...
February 2, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Jeong Seok Seo, Won-Myong Bahk, Hee Ryung Wang, Young Sup Woo, Young-Min Park, Jong-Hyun Jeong, Won Kim, Se-Hoon Shim, Jung Goo Lee, Duk-In Jon, Kyung Joon Min
Objective: In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. Methods: Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies...
February 28, 2018: Clinical Psychopharmacology and Neuroscience: the Official Scientific Journal of the Korean College of Neuropsychopharmacology
Georgina Perez-Garcia, Rita De Gasperi, Miguel A Gama Sosa, Gissel M Perez, Alena Otero-Pagan, Anna Tschiffely, Richard M McCarron, Stephen T Ahlers, Gregory A Elder, Sam Gandy
Battlefield blast exposure related to improvised explosive devices (IEDs) has become the most common cause of traumatic brain injury (TBI) in the recent conflicts in Iraq and Afghanistan. Mental health problems are common after TBI. A striking feature in the most recent veterans has been the frequency with which mild TBI (mTBI) and posttraumatic stress disorder (PTSD) have appeared together, in contrast to the classical situations in which the presence of mTBI has excluded the diagnosis of PTSD. However, treatment of PTSD-related symptoms that follow blast injury has become a significant problem...
January 2018: ENeuro
Svetla Gadzhanova, Elizabeth E Roughead, Lisa G Pont
BACKGROUND: Switching between antidepressants is complex due to potential adverse outcomes such as serotonin syndrome and antidepressant discontinuation syndrome, yet switching is often required due to non-response to initial treatment. This study aimed to examine the patterns and extent of antidepressant switching in a cohort of older adults in long-term residential care. METHODS: A cohort study of medication supply data from 6011 aged care residents in 60 long-term care facilities was conducted...
January 30, 2018: International Psychogeriatrics
Maria Gustafsson, Maria Sjölander, Bettina Pfister, Jörn Schneede, Hugo Lövheim
Age-associated physiological changes and extensive drug treatment including use of potentially inappropriate medications (PIMs) pose a significant risk of drug-drug interactions and adverse drug events among elderly people with dementia. This study aimed at analysing the effects of clinical pharmacists' interventions on use of PIMs, risk of emergency department visits, and time to institutionalization. Furthermore, a descriptive analysis was conducted of circumstances associated with drug-related readmissions...
January 16, 2018: Pharmacy (Basel, Switzerland)
Marjorie A Bowman, Dean A Seehusen, Anne Victoria Neale
Being realistic while helping our patients is this issue's theme. Given the volume of tasks required in family medicine, recommendations for improvements in direct care or care measurement cannot just be evidence-based but must also be realistic. On the list of realistic: ordering antipsychotics for symptoms of dementia in the elderly, despite recommendations to not do so; ordering antidepressants without fear that the patient could develop hypertension; mental health care providers in primary care offices; forced choice for opioid management; plus agenda setting for visit efficiency...
January 2018: Journal of the American Board of Family Medicine: JABFM
Lidan Dong, Ling Xu, Yanfei Li, Yinghua Lv, Hongxia Liu, Yunfei Li, Fengyan Xu, Junyi Wu, Qingshan Zheng, Lujin Li
BACKGROUND: The high heterogeneity was existed among the studies of the elderly participants with major depressive disorder (MDD), which may lead to incorrect conclusions in the previous meta-analysis. This study used model based meta-analysis to compare the efficacy of fluoxetine between the elderly and non-elderly participants with MDD and to explain the heterogeneity among the studies. METHODS: A comprehensive literature search was conducted in the public databases, involving utilization of fluoxetine for treating MDD in the acute-phase...
January 3, 2018: Journal of Affective Disorders
Isabella Aquila, Santo Gratteri, Matteo A Sacco, Emilio Nuzzolese, Vittorio Fineschi, Paola Frati, Pietrantonio Ricci
INTRODUCTION: "Bolus death" or "Café Coronary syndrome" refers to death due to asphyxia caused by an occlusion of the upper airways due to food. In this kind of asphyxia, the food bolus obstructs the larynx or the bronchial branches. This kind of event often affects subjects with acute intoxication due to alcohol or drugs, or with edentulism and with neurological or psychiatric diseases. CASE REPORT: An elderly woman, suffering from schizophrenia, was found dead in her house due to food bolus asphyxia...
January 2018: Medical Hypotheses
M Vidgren, J K Virtanen, T Tolmunen, T Nurmi, T-P Tuomainen, S Voutilainen, A Ruusunen
OBJECTIVES: Low concentrations of serum 25-hydroxyvitamin D [25(OH)D] have been postulated to associate with an increased prevalence of depression. As there are a limited number of publications on this issue, we examined the association between serum 25(OH)D and depression in a general middle-aged or older population. DESIGN: A population-based cross-sectional study. SETTING AND PARTICIPANTS: A total of 1602 men and women from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) in Eastern Finland, aged 53-73 y in 1998-2001, were analysed...
2018: Journal of Nutrition, Health & Aging
Yue Leng, Susan J Diem, Katie L Stone, Kristine Yaffe
Background: Antidepressant use is very common in the elderly, but the effects of antidepressants on cognition in the elderly are controversial with some studies suggesting harm and others protection. We aimed to investigate the association between different antidepressant use and change in cognition and risk of mild cognitive impairment (MCI) or dementia in very old women. Methods: We examined 1,234 community-dwelling women (mean age 83.2 years) from the Study of Osteoporotic Fractures...
December 12, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Maria Aparecida Medeiros Barros do Prado, Priscila Maria S Bergamo Francisco, Marilisa Berti de Azevedo Barros
OBJECTIVE: to estimate the prevalence of use of psychotropic medicines and associated factors in adults and elderly, and to identify the main classes used. METHODS: cross-sectional population-based study, conducted in Campinas-SP, Brazil (January/2008-April/2009); chi-square Rao-Scott test and Poisson multiple regression were applied. RESULTS: the study included 2,472 individuals and the prevalence of use of at least one psychotropic medication in the three previous days was 6...
October 2017: Epidemiologia e Servicos de Saude: Revista do Sistema Unico de Saude do Brasil
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