Section - Quick Takes

05. Geriatric Depression: Ranking Antidepressant Efficacy, Tolerability, and Outcomes

Published on August 1, 2024 Certification expiration date: August 1, 2027

Scott R. Beach, M.D.

Associate Professor of Psychiatry - Harvard Medical School - Massachusetts General Hospital

Key Points

Sertraline may be a good first-choice antidepressant for older patients, as it performed well in this study and has a favorable safety profile.
Prescribers should exercise caution when using venlafaxine or mirtazapine in older adults, as they were associated with higher rates of adverse events.
The study's observational nature and potential for indication bias should be considered when interpreting the results, as noted by the authors themselves.

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Venlafaxine XR: A Go-To Antidepressant for Older Patients?

When I was in my third year of residency training, we had a specific geriatric psychiatry clinic every Monday morning. We’d staff cases with one of our geriatric psychiatrists and see a panel of followup patients, most presenting for depression or anxiety.

There was a joke amongst the residents because if you were seeing a patient in the geriatric clinic for depression, you were only really ever allowed to prescribe one medication: extended-release venlafaxine. This was just based on the clinical experience of the attending that venlafaxine XR worked uniquely well in this population and was very well tolerated.

As a result, I became extremely adept at titrating the medication, monitoring blood pressure, and checking for side effects. And sure enough, most of my patients did very well, reporting improvements in their depression with minimal side effects.

Surprising Results from a Danish

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Table of Contents

Learning Objectives:

After completing this activity, the learner will be able to:

Evaluate the risks and benefits of co-prescribing SSRIs and oral anticoagulants, particularly in the first month of combined use.
Describe patterns of long-term benzodiazepine use and dose escalation in adult patients, including risk factors for dose escalation.
Assess the impact of antidepressant medication on cognitive symptoms in late-life depression, particularly in the domains of memory and learning.
Compare and contrast management strategies for common neuropsychiatric syndromes in neurodegenerative diseases, including psychosis, agitation, and depression.
Analyze the efficacy, tolerability, and outcomes of different antidepressants in geriatric patients with depression based on real-world data.

Original Release Date: August 1, 2024

Expiration Date: August 1, 2027

Experts: Scott Beach, M.D., Paul Zarkowski, M.D.

Medical Editor: Flavio Guzmán, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.