Dorman T
Br J Clin Pract. 1988 Nov;42(11):459-64.
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 The newer non-tricyclic antidepressants have revealed further problems, with two of these agents being withdrawn because of serious side effects.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.
与年轻患者相比，老年抑郁症患者的治疗因一些额外因素而变得复杂。老年人的主要差异因素是不良生活事件的发生率和严重程度增加，以及社会劣势的相应增加。相关的身体问题更为常见，而且自杀可能性显著增加——老年人约占总人口的12%，但在所有完成的自杀案例中约占33%。虽然有人对化疗的结果表达了一些悲观看法，但对许多患者来说，化疗是治疗的基石，较老的三环类抗抑郁药仍被广泛使用。然而，这些药物有严重的缺点。过量服用时它们毒性很高，在治疗剂量下具有明显的抗胆碱能作用和对心血管系统的显著不良反应。较新的非三环类抗抑郁药也出现了进一步的问题，其中两种药物因严重副作用而被撤出市场。在此背景下，改良的三环化合物洛非帕明的引入备受关注，因为与较老的抗抑郁药相比，其毒性和抗胆碱能作用大大降低。一项对210名老年抑郁症患者（平均年龄75.8岁）使用洛非帕明的回顾性研究结果表明，大多数此类患者对积极治疗会有反应。70%的患者症状有良好至完全缓解的反应，总体耐受性良好。
