Antidepressants
An important topic for those of us who care for older adults is antidepressants, These are frequently used in the treatment of depression, if you work caring for older adults, this post will be very useful, if you have a family member who is experiencing depression or taking this type of medication, it may also be of interest to you, to search for more information on the subject and/or to find specialized help.
Classification according mechanism of action
Below, I present an updated classification of these drugs according to their mechanism of action.
Class A: Monoaminergic modulators
Class A I: Monoamine oxidase inhibitors (MAOIs)
AIa: Irreversible non-selective Tranylcypromine, Phenelzine, Isocarboxazid
AIb: Irreversible selective MAO-B: Selegiline
AIc: Reversible selective MAO-A: Moclobemide
Class A II: Neuronal reuptake inhibitors
AIIa: Relatively selective
AIIa: Serotonergic: Selective serotonin reuptake inhibitors (SSRIs): Fluoxetine, Sertraline, Paroxetine, Citalopram, Escitalopram), Fluvoxamine
AIIb: Serotonergic and noradrenergic Serotonin-noradrenaline reuptake inhibitors (SNRI): Venlafaxine, Desvenlafaxine, Duloxetine, Milnacipran, Levomilnacipran
AIIc: Noradrenergic and dopaminergic Noradrenaline and dopamine reuptake inhibitor (NDRI): Bupropion
Class A III: Alpha-2 (α2) receptor antagonists Noradrenergic and specific serotonergic antidepressant (NaSSA): Mirtazapine
Class A IV: Multimodals
AIVa: Serotonergics: Vortioxetine, Vilazodone, Trazodone(2) AIVb: Noradrenergics: Mianserine, Maprotiline
AIVc: Noradrenergic and serotonergics (with significant muscarinic antagonism): Imipramine, Clomipramine, Amitriptyline, Desipramine, Nortriptyline
Class B: Non-Monoaminergic modulators
Melatonin receptors (MT1 and MT2) agonists: Agomelatine
Class C: Drugs in research and development
source: Alvano & Zieher (2020)
The most commonly used by older adults are selective serotonin reuptake inhibitors, such as sertraline, fluoxetine, and paroxetine. These medications are usually safe and effective in this population, but it is always important to consult with a specialist before starting any treatment. Fasipe (2018)
Long-term use of antidepressants, especially in older adults, may have some side effects, which may include:
- Increased risk of falls and fractures due to decreased balance and coordination.
- Gastrointestinal problems, such as nausea, diarrhea, or constipation.
- Sleep disturbances, such as insomnia or excessive drowsiness.
- Decreased appetite or weight gain.
- Risk of serotonin syndrome, especially if taken along with other medications that increase serotonin levels in the body.
- Sexual problems, such as decreased sexual desire or difficulties achieving orgasm.
- Increased risk of bleeding, especially in people taking anticoagulants.
It is important for older adults taking antidepressants to be regularly monitored by a doctor to detect and manage any potential side effects.
Tips:
If you are caring for an older adult or working in an ALF( assisted living facility) take into account the antidepressant medications that the patient(s) are taking, as well as their daily dosage and frequency. Be alert to any changes in behavior or clinical symptoms that may indicate they are experiencing adverse or side effects after taking the medication and report it to their family members or administrators so that they can take action and solve the problem in time.
If you liked the publication, comment and share. Your comments can help improve my posts and suggest topics of interest. I leave the references for you to delve deeper into this topic. In my next post, I will talk about the psychology of the older adult.
References
Alvano, S. A., & Zieher, L. M. (2020). An updated classification of antidepressants: A proposal to simplify treatment. Personalized Medicine in Psychiatry, 19, 100042. Available in
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