Risk Profile of SSRIs in Elderly Depressive Patients with Co-Morbid Physical Illness

Background: So far, most studies on treatment strategies in elderly depressive patients have included only patients in good physical health, thereby excluding and neglecting somatic co-morbidity, which is very prevalent and relevant in geriatric psychiatry. Method: 40 elderly depressive inpatients at the Department of Internal Medicine in Hochzirl who had started on SSRI monotherapy were allocated to this prospective post-marketing surveillance study. A stable medication for their physical illness for at least six months was a prerequisite. A Mini Mental State Exam (MMSE) score of > 24 was required for study entry. The four-week study consisted of one baseline and four follow-up examinations, including psychiatric and medical history, as well as ratings for psychopathology and treatment-related adverse events. The antidepressants administered were paroxetine (20 mg/d), citalopram (20 mg/d), fluoxetine (20 mg/d) and sertraline (50 mg/d). Depression was rated using the 21-item Hamilton Depression Scale (HAMD); side effects were evaluated by the UKU Side Effect Rating Scale, and we used the Hillside Akathisia Scale (HAS) to record the incidence of SSRI-induced akathisia. Results and Conclusion: Our results suggest that SSRIs are effective and reasonably safe in elderly depressive patients with co-morbid physical illness. Adverse effects are more common, but generally tolerable, than in younger and physically healthy patients. The risk profile of SSRIs in this population can be considered favorable.

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