The management of depression, and the use of lofepramine in the elderly.

Treatment of depression in the elderly compared with younger patients is complicated by a number of additional factors. The main differential factors in the elderly are an increased incidence and severity of adverse life events and a parallel increase in social disadvantages. Associated physical problems are much more frequently encountered, and there is a striking increase in suicidal potential--with the elderly accounting for some 12 per cent of the population but being involved in some 33 per cent of all completed suicides. While some pessimistic views have been expressed about the outcome of chemotherapy, this is for many patients the cornerstone of treatment, with the older tricyclic antidepressants still used extensively. However, these agents have serious disadvantages. They are highly toxic in overdosage, with pronounced anticholinergic actions and marked adverse effects on the cardiovascular system in therapeutic dosage. The newer non-tricyclic antidepressants have revealed further problems, with two of these agents being withdrawn because of serious side effects. Against this background, the introduction of the modified tricyclic compound lofepramine was of major interest in the light of its much reduced toxicity and anticholinergic effects when compared with older antidepressants. The results of a retrospective study involving the use of lofepramine in a series of 210 elderly depressives (mean age 75.8 years) suggests that a majority of such patients will respond to energetic treatment. Seventy per cent of the patients showed a response ranging from good to complete remission of symptoms and overall tolerability was excellent.