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Article |

Treatment of Depression in the Elderly

Gary W. Small, MD
JAMA. 1983;249(17):2330-2331. doi:10.1001/jama.1983.03330410028020.
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To the Editor.—  When so notable a psychopharmacologist as Dr Uhlenhuth (1982;248:1879) discusses antidepressants, people listen. It is for this reason that I feel impelled to point out that physicians treating geriatric patients with depression need additional information not mentioned in Dr Uhlenhuth's editorial. First, recent studies1,2 indicate that, in the geriatric population, response to tricyclic antidepressants occurs within the first week of treatment and predicts remission. Second, although benzodiazepines may be effective in treating the anxiety that often accompanies major depression, such beneficial effects are overshadowed by the risk of ataxia in the elderly. Moreover, these anxiolytics often accumulate in blood and other tissues of elderly patients, causing oversedation and worsening of depressive symptoms. Although antidepressants, too, are potentially toxic in the elderly, when prescribed in low doses with gradual increments, they are generally safe and effective. In situations complicated by concomitant illnesses, drug intolerance, or danger of


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