Pharmacotherapy in older depressed patients.

Treatment of depression in elderly patients is not generically different from treatment of depression in younger age cohorts. Because of certain age-related physical, physiological, and biochemical factors, however, drug prescription for geriatric patients must be modified in several respects. Tricyclic antidepressants are the principal agents in treatment, but their side effects tend to be magnified in the elderly. Dosage should initially be lower than with younger patients and increased in gradual increments. Lithium, MAO inhibitors, and neuroleptics are appropriate in some cases, but additional precautions are necessary. Because the elderly are liable to multiple system decompensation, they are likely to be prescribed multiple pharmacological agents. Drug-drug interactions involving antidepressant medication present a variety of therapeutic problems and can threaten life. Depression in late life can be treated pharmacologically, but both the therapeutic and deleterious activities of the drugs can be altered by compromised organ systems.