Skerritt U, Evans R, Montgomery S A
Imperial College of Science Technology, St Mary's Hospital Medical School, London, England.
Drugs Aging. 1997 Mar;10(3):209-18. doi: 10.2165/00002512-199710030-00005.
Depression is a serious illness that is common in the elderly but which is frequently overlooked. Management is complicated by physiological changes associated with aging, the presence of comorbid physical illness, and compliance problems; these factors must be taken into account when selecting an appropriate antidepressant. The well known problems associated with the tricyclic antidepressants (TCAs) [i.e. their unwanted anticholinergic, adrenergic and histaminergic effects], which are troublesome in younger patients, can have serious consequences for elderly depressed patients. The TCAs can cause symptoms that worsen concomitant physical illness, which is frequently present in the elderly, and their cardiotoxicity in overdose is of concern in both younger and older patients. The selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors have been shown to be as efficacious as the TCAs in the general depressed population, but to lack the anticholinergic adverse effects and cardiotoxicity associated with those drugs. Their increased safety and tolerability makes them a preferred treatment for depressed elderly patients.
抑郁症是一种严重疾病，在老年人中很常见，但常被忽视。衰老相关的生理变化、合并躯体疾病的存在以及依从性问题使治疗变得复杂；选择合适的抗抑郁药时必须考虑这些因素。三环类抗抑郁药（TCAs）存在的众所周知的问题[即其不良的抗胆碱能、肾上腺素能和组胺能效应]，在年轻患者中就很麻烦，而对老年抑郁症患者可能产生严重后果。TCAs可引发使并存的躯体疾病恶化的症状，而这在老年人中很常见，并且其过量时的心脏毒性在年轻和老年患者中都令人担忧。在一般抑郁症患者群体中，选择性5-羟色胺（5-羟色胺；5-HT）再摄取抑制剂已被证明与TCAs疗效相当，但没有那些药物相关的抗胆碱能不良反应和心脏毒性。其更高的安全性和耐受性使其成为老年抑郁症患者的首选治疗药物。
