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Prescribing for Older Adults

Major depressive disorder (MDD) is a common condition that affects approximately 2.6 million Americans annual. Depression in older adults is not a normal part of the aging population. Depression in older adults differs from depression in the general adult population. In older adults, depression typically takes place concurrently with other comorbidities. The United States Food and Drug Administration has approved Sertraline (Zoloft) in the treatment of depression. According to Katona et al. (2014). Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are the first-line treatment for older adults. Research shows that studies lasting ten weeks or more showed more significant superiority for active drugs over placebo than studies lasting 6-8 weeks, supporting the belief that antidepressant response may take longer to emerge in older people. Buspirone (Buspar) which is FDA approved for the treatment of anxiety, can be used off-labeled to treat depression. Research shows that at higher doses, Buspirone has significant antidepressant efficacy (Howland, 2015). MDD can be a serious threat to elderly individuals and difficult to treat. However, with adequate treatment, these individuals can thrive and make a full recovery. Cognitive behavior therapy is a nonpharmacological intervention that can be used as a first-line treatment for depression. Older clients tend to have a positive attitude regarding psychotherapy and prefer it instead of pharmacological therapy. Research has demonstrated that psychotherapy is an effective evidence-based practice to treat depression in the elderly (Carter et al., 2021)

An SSRI such as sertraline is relatively safe to use in elderly individuals. The advantages of these drugs are that they have lower anticholinergic effects and are well tolerated by patients with cardiovascular disease. There is also a decreased risk for overdose. The risks of taking SSRIs are an increased risk of falls, hyponatremia, and gastrointestinal bleed. The benefits of Buspar are the safety profile, lack of dependence and withdrawal, lack of weight gain, and the lack of sexual dysfunction. The risk associated with this medication is that it should not be used in patients with renal and hepatic impairment (Stahl, 2014). The American Psychological Association (2019) practice guidelines recommend using SSRIs such as escitalopram or sertraline in the elderly population because it has lower anticholinergic side effects. It also recommends cognitive-behavioral therapy as an initial treatment for treating minor or major depressive disorder.

References

American Psychological Association. (2019). Clinical practice guideline for the treatment of

depression across three age cohorts. APA Depression Guideline

Carter, J. D., Jordan, J., McIntosh, V. V., Frampton, C. M., Lacey, C., Porter, R. J., & Mulder, R.

T. (2021). Long-term efficacy of metacognitive therapy and cognitive behaviour therapy for depression. The Australian and New Zealand Journal of Psychiatry, 48674211025686. https://doi-org.ezp.waldenulibrary.org/10.1177/00048674211025686

Howland, R. H. (2015). Buspirone: Back to the future. Journal of Psychosocial Nursing and

Mental Health Services, 53(11), 21–24. https://doi-org.ezp.waldenulibrary.org/10.3928/02793695-20151022-01

Katona, C., Bindman, D. C., & Katona, C. P. (2014). Antidepressants for older people: What can

we learn from the current evidence base? Maturitas, 79(2), 174–178. https://doi-org.ezp.waldenulibrary.org/10.1016/j.maturitas.2014.05.016

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). Cambridge University Press