Tag: medication

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.