Tag: anxiety

Updated Classification of Antidepressants for Older Adults: A Simplified Guide

Posted on by Maritza Osorio

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:

  1. Increased risk of falls and fractures due to decreased balance and coordination.
  2. Gastrointestinal problems, such as nausea, diarrhea, or constipation.
  3. Sleep disturbances, such as insomnia or excessive drowsiness.
  4. Decreased appetite or weight gain.
  5. Risk of serotonin syndrome, especially if taken along with other medications that increase serotonin levels in the body.
  6. Sexual problems, such as decreased sexual desire or difficulties achieving orgasm.
  7. 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 

Understanding Benzodiazepines and Their Impact on Older Adults.

Posted on by Maritza Osorio

Benzodiazepines are a class of medications that act on the central nervous system to produce sedative, anxiolytic, hypnotic, anticonvulsant, and muscle relaxing effects. They are commonly prescribed to treat anxiety disorders, insomnia, seizures, and other nervous system-related issues. However, their prolonged use can lead to dependence and other adverse effects. The most commonly used by older adults are those with a shorter half-life and less tendency to accumulate in the body, such as lorazepam (Ativan), alprazolam (Xanax), and oxazepam (Serax). These are preferred due to their lower potential to cause adverse effects and accumulation in the body. However, their use must be carefully monitored due to the risk of dependence and side effects, particularly in older adults, where they may increase the risk of falls, confusion, excessive drowsiness, and loss of memory and attention, in addition to their prolonged use potentially leading to dependence and tolerance, which complicates withdrawal.

This pharmacological group has interactions due to its metabolism (pharmacokinetics), increasing benzodiazepine concentrations in relation to medications like digoxin, omeprazole, and beta-blockers, which are frequently used by older adults. Additionally, in terms of effect (pharmacodynamics), antidepressants, anticonvulsants, neuroleptics, and antihistamines enhance their depressive effects.

The use of these medications should be evaluated by psychiatrists, and depending on the clinical picture, comorbidities, and the age of the older adult, the prescription of benzodiazepines will proceed or not.

If you liked the post, give me a like and/or comment. Your interaction can help improve my posts.

References

Hirschtritt, M. E., Olfson, M., & Kroenke, K. (2021). Balancing the risks and benefits of benzodiazepines. Jama, 325(4), 347-348.es

Ballokova, A., Peel, N. M., Fialova, D., Scott, I. A., Gray, L. C., & Hubbard, R. E. (2014). Use of benzodiazepines and association with falls in older people admitted to hospital: a prospective cohort study. Drugs & aging, 31, 299-310.

Squizoprhenia,anxiety, and mood disorders.

Posted on by Maritza Osorio

All people who work with people with dementia, schizophrenia, behavioral disorders, anxiety and depression, must have knowledge basic to have effective communication, when you help them if you work in a daycare, assisting living facility, nursing home, hospital or if you live with them at home. That is why I write in this blog because some aspects of its pathophysiology must be known.

Pathophysiology is the study of the functional and physiological changes that occur in the body as a result of disease or injury. It examines how the normal processes of the body are altered and how these alterations lead to the manifestation of symptoms and clinical signs of specific diseases. It is a fundamental discipline for understanding the basis of various diseases and for developing strategies for diagnosis and treatment.

This post will address schizophrenia, anxiety, and mood disorders.

Schizophrenia is a psychiatric illness characterized by a combination of symptoms that includes hallucinations, delusions, disorganized thinking, and cognitive impairment associated with an imbalance of dopamine and serotonin, as well as hypofunction of the prefrontal cortex and hyperactivity of the amygdala.

At present, the molecular mechanism of schizophrenia is not completely known, but there is strong scientific evidence that supports the genetic component in its pathophysiology. Twin and family studies have shown that people with close relatives with schizophrenia have a greater probability of having schizophrenia, multiple genes are believed to interact, influencing the regulation of glutamate signals, synaptic function, DNA transcription and chromatin remodeling.

Alterations in brain development during pregnancy and early childhood increase the risk, exposure to environmental toxins, viral infections during pregnancy, complications during childbirth can increase the possibility of getting sick in later stages, chronic stress, Drug use such as marijuana or methamphetamine and traumatic experiences in childhood are environmental factors involved in the development of schizophrenia.

Anxiety disorders are an exaggerated anxiety response to everyday activities. Its pathophysiology presents an interaction of genetic, neurochemical and environmental factors as well as disorders in serotonin, norepinephrine and GABA, just as in schizophrenia the prefrontal cortex and the amygdala are involved.

Mood disorders such as depression and bipolarity alter mood and functionality; the neurotransmitters serotonin, norepinephrine, and dopamine are involved, as well as alterations in neuronal activity and synaptic plasticity in the hippocampus and prefrontal cortex, as well as the regulation of the circadian rhythm that brings with it extreme changes in moods.

Further Beyond the medications that these people consume to calm their anxiety, depression, improve their memory, and be able to sleep, we must look at the human side of these patients who are invisible to society and an economic burden for their families. Kind and respectful treatment restores their dignity.