Drugs Aging. 1997 Aug;11(2):119-31.  

Antidepressant use in the elderly. Current status of nefazodone, venlafaxine and
moclobemide.

Goldberg RJ.

Department of Psychiatry, Rhode Island Hospital, Brown University, Providence,
USA.

Depression is a significant problem in the elderly. Because of aging-related
pharmacokinetic and pharmacodynamic changes, it is not possible to automatically
extrapolate findings on the efficacy or tolerability of antidepressants from
younger to older populations. Venlafaxine inhibits both noradrenaline
(norepinephrine) and serotonin (5-hydroxytryptamine; 5-HT) reuptake. Analysis of
data from phase II and III trials showed that venlafaxine was comparably
effective in the young and in a subset of over 350 elderly patients. Venlafaxine
dosage needs to be lowered in the elderly with renal impairment. As a weak
cytochrome P450 (CYP) inhibitor, it is unlikely to have clinically significant
drug interactions. Venlafaxine may be associated with some increase in supine
diastolic blood pressure, especially at dosages above 150 mg/day. Nefazodone is
a serotonin uptake inhibitor and serotonin 5-HT2A receptor antagonist. Pooled
analysis of about 250 patients found nefazodone to be effective in elderly
individuals with moderate or severe depressive symptoms, with or without
melancholia, in both primary and recurrent episodes. Nefazodone clearance is
reduced in patients with hepatic impairment, and plasma concentrations have been
reported to be higher in the elderly. Nefazodone is an inhibitor of the CYP3A4
family. There does not appear to be any increase in the frequency or severity of
adverse effects in the elderly. Moclobemide is a selective inhibitor of
monoamine oxidase type A. Studies in the elderly have found it to be well
tolerated and meta-analysis has shown it to be comparably effective in young and
elderly populations, and comparable to other antidepressants in terms of
efficacy. Neither age nor renal impairment necessitate dosage adjustment, but
hepatic impairment does necessitate dosage reduction. Dietary restrictions are
not required. Overall, there is a relative paucity of data on the tolerability
and efficacy of newer antidepressants in the elderly, especially those with
concomitant medical disorders. Data that are available indicate that
venlafaxine, nefazodone and moclobemide have comparable efficacy in older and
younger patients.

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    Review, Tutorial

PMID: 9259175 [PubMed - indexed for MEDLINE]