Geriatric Depression

Question 1

What are the signs and symptoms of geriatric depression?

Answer 1

• Impaired memory
• Poor concentration
• Low energy
• Social withdrawal
• Decreased appetite

Question 2

Name first-line medications for geriatric depression. Why?

Answer 2

First-line meds: SSRI’s
- Citalopram
- Escitalopram
- Sertraline

Why?
- fewest drug-drug interactions
- greater safety and tolerability

Question 3

Which antidepressants should be avoided in those aged 65 and older? Why?

Answer 3

TCA’s (tricyclics antidepressants):
- Arrhythmias
- Cognitive changes
- Urinary retention worsens
- Rule out overdose (even with as few as 1-week supply)

Paroxetine:
- Anticholinergics effects (like TCA’s)

Fluoxetine:
- Prolonged side effects due to long half-life

Question 4

What are the potential side effects of SSRI use with geriatrics?

Answer 4

• Parkinsonism
• Sinus bradycardia
• Bleeding (especially if ASA/anticoagulant on board)
• Fragility fractures (from even minimal trauma)
• Anorexia
• Hyponatremia

** May be related to “serotonin transporter” in:
- gut
- brain
- bone
- blood vessels