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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on October 17, 2016, at 18:34:35
UPDATED October 14, 2016 // WASHINGTON, DC Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), can significantly disrupt sleep architecture in elderly patients and may contribute to early signs of neurodegeneration that can progress to dementia, new research shows."We take into account other side effects of antidepressants, including weight gain and sexual side effects, but we are less concerned about sleep, especially when we use the SSRIs," Muhammad Tahir, MD, psychiatry resident, SUNY Upstate Medical University, Syracuse, New York, told Medscape Medical News.
"But the SSRIs increase sleep latency in the elderly and decrease REM [rapid eye movement] sleep duration and are also associated with REM sleep behavioral disorders, including nightmares," he added.
"So our literature review suggests that we should be careful about using SSRIs in the elderly population and not underestimate the effectiveness of psychotherapy and other holistic care approaches for the elderly," Dr Tahir said.
The study was presented here at the Institute of Psychiatric Services (IPS): The Mental Health Services 2016 Conference.
The literature review included 10 studies published within the past 5 years. The studies included systemic reviews, retrospective studies, and prospective studies, and patients had to be at least 50 years of age and receiving an antidepressant, largely an SSRI, for the treatment of depression.
Analyses revealed that not only did the SSRIs in particular change sleep architecture in older patients, they also appeared to increase the risk for REM behavioral disorders.
REM sleep behavioral disorders are characterized by normal brain activity, but the body is agitated and is not sleeping. This may be an early sign of neurodegeneration, said Dr Tahir.
Changes in the sleep architecture brought on by antidepressant therapy may result in agitation, Dr Tahir noted, which may prompt further treatment with further side effects.
Unfortunately, there is little evidence to support the use of any treatment other than the SSRIs for depression in the elderly.
Both the tricyclic antidepressants and the monoamine oxidase inhibitors are associated with too many side effects, especially in the elderly, and are generally not used in older patients.
Benzodiazepines in turn are associated with an increased risk for falls and again are inappropriate for use in the elderly.
Dr Tahir suggested that psychiatrists screen their elderly patients for any signs and symptoms of neurodegenerative disorders and, if an SSRI is prescribed, ask detailed questions about sleep quality on all follow-up visits.
SSRI Dosing Important
Commenting on the findings for Medscape Medical News, Peter Yellowlees, MD, professor of psychiatry, University of California, Davis, said the analysis, though interesting, does not include information on the doses of the SSRIs used in the studies that were included for review.
"In the elderly, these doses should be a maximum of half of the usual dose prescribed for younger patients," Dr Yellowlees observed.
As for the possible association between SSRI use and neurodegenerative disease, Dr Yellowlees also noted that SSRIs are not necessarily causative.
"Rather, it may simply be that in the early stages of these diseases, depression and agitation are more common, and hence antidepressants are more commonly prescribed," he noted.
In fact, the same association has been reported between the benzodiazepines and neurodegenerative disease that has been reported in the new study with respect to SSRIs, Dr Yellowlees pointed out.
"The jury is definitely out on the connection between degenerative disorders and medications, but in my view, there is not a lot of evidence to suggest that there is a causative link, although there does seem to be an association," Dr Yellowlees suggested.
"The key issue here is that depression in the elderly is common and can be debilitating and is very treatable with both medications in lower doses than usually prescribed in younger patients along with behavioral interventions."
Dr Tahir and Dr Yellowlees have disclosed no relevant financial relationships.
Institute of Psychiatric Services (IPS): The Mental Health Services 2016 Conference. Abstract 14. Presented October 7, 2016.
Posted by Phillipa on October 17, 2016, at 18:36:41
In reply to SSRI's not good for older people over 50 + TCI + M, posted by Phillipa on October 17, 2016, at 18:34:35
Tricyclics are definitely out as well as MAOI's. So what now. Oh also benzos included
Posted by rjlockhart37 on October 17, 2016, at 23:27:13
In reply to Re: SSRI's not good for older people over 50 + TCI + M, posted by Phillipa on October 17, 2016, at 18:36:41
the new generation coming in right now, the serotonin modulators like trintellix are more better, SSRI's had their popularity in the 90s-2000s and it's coming to an end......
Posted by TriedEveryMedication on October 18, 2016, at 5:51:47
In reply to Re: SSRI's not good for older people over 50 + TCI + M, posted by rjlockhart37 on October 17, 2016, at 23:27:13
> the new generation coming in right now, the serotonin modulators like trintellix are more better, SSRI's had their popularity in the 90s-2000s and it's coming to an end......
>
>Isn't part of B/Trintellix mechanism of action still basically binding with serotonin transporter (SERT), just like SSRIs? (And plus some other receptor stuff)
I suspect Trintellix will cause the same harm as SSRIs... unless that other receptor stuff that Trintellix affects will mediate that.
Posted by SLS on October 18, 2016, at 7:06:01
In reply to Re: SSRI's not good for older people over 50 + TCI + M, posted by Phillipa on October 17, 2016, at 18:36:41
> Tricyclics are definitely out as well as MAOI's. So what now. Oh also benzos included
Did you see the following passage when you read the article?
"As for the possible association between SSRI use and neurodegenerative disease, Dr Yellowlees also noted that SSRIs are not necessarily causative. "Rather, it may simply be that in the early stages of these diseases, depression and agitation are more common, and hence antidepressants are more commonly prescribed,""
I would agree that this is a possibility.
There is something known as "pseudodementia". Pseudo- obviously means "false". Pseudodementia resembles age-related dementia, but is actually the way Major Depressive Disorder presents in older people.
Bupropion (Wellbutrin) and trimipramine (Surmontil) actually enhance sleep quality. Both of these drugs should be studied for use in pseudodementia. I don't think they have been. I would look at trimipramine in particular, as it may not produce agitation the way Wellbutrin sometime does in younger people.
Phillipa, I think you might remain ill indefinitely - only because of your reluctance to explore treatments that you have not yet tried. Do you agree? That you feel much better when you are riding your bike is a clue as to how to treat your anxiety/depression. Do things improve when you are treated using psyschotherapy? It is almost as if you have been entrained to feel bad at home. Perhaps classical conditioning were operating. If it isn't a matter of problematic psychology that plagues you, perhaps you can try one of the newer antidepressants, or even an antipsychotic with antidepressant and anxiolytic properties. You don't have to be psychotic to profit from using an antipsychotic.
- Scott
Posted by Christ_empowered on October 18, 2016, at 7:40:58
In reply to Re: SSRI's not good for older people over 50 + TCI + M » Phillipa, posted by SLS on October 18, 2016, at 7:06:01
back in the day, ritalin and sometimes amphetamines were used in older people w/ depression, fatigue, etc. I heard about a small study..ritalin+celexa or something, in older people...worked faster w/ less fatigue, sedation, etc.
Posted by Phillipa on October 18, 2016, at 9:55:30
In reply to Re: SSRI's not good for older people over 50 + TCI + M » Phillipa, posted by SLS on October 18, 2016, at 7:06:01
I saw the passage. I feel the worse after take synthroid for thyroid middle of night. When out of the house I feel better. When doing any sort of exercise I also feel better. The biggest loss I have is the 14 years now of absolutely no taste and smell. No social life as everything revolves around food. To never smell a flower or taste yes cottage cheese is the biggest loss to me. And losing these senses is the cause of depression. So I force the food I know I need to eat.. Same diet daily and have to drink 2 bottles of water and 2 of green tea both with a lot of added pure lemon juice as can taste the sour. Then the chocolate at night time. And attending PT twice a week for the excruciating back pain that is from two scoliosis's and arthritis, spinal stenosis, bone spurs, If I had my smell and taste back and could do the work I need to do to feel useful that would be my magic pill. Since only take the meds at night I feel a lot better later in the afternoon and when outside. Which says to me that I don't need the meds just give me taste and smell and lack of pain and all is good. . Anyway I also read on here the internet that when one doesn't eat anymore that their body is dying. The internet can be dangerous to me. Phillipa
Posted by TriedEveryMedication on October 18, 2016, at 22:13:39
In reply to Re: SSRI's not good for older people over 50 + TCI + M, posted by Phillipa on October 17, 2016, at 18:36:41
Posted by SLS on October 18, 2016, at 23:30:29
In reply to Re: SSRI's not good for older people over 50 + TCI + M » Phillipa, posted by SLS on October 18, 2016, at 7:06:01
> > Tricyclics are definitely out as well as MAOI's. So what now. Oh also benzos included
> Did you see the following passage when you read the article?
>
> "As for the possible association between SSRI use and neurodegenerative disease, Dr Yellowlees also noted that SSRIs are not necessarily causative. "Rather, it may simply be that in the early stages of these diseases, depression and agitation are more common, and hence antidepressants are more commonly prescribed,""
>
> I would agree that this is a possibility.
>
> There is something known as "pseudodementia". Pseudo- obviously means "false". Pseudodementia resembles age-related dementia, but is actually the way Major Depressive Disorder presents in older people.
>
> Bupropion (Wellbutrin) and trimipramine (Surmontil) actually enhance sleep quality. Both of these drugs should be studied for use in pseudodementia. I don't think they have been. I would look at trimipramine in particular, as it may not produce agitation the way Wellbutrin sometime does in younger people.I forgot about Trintellix (vortioxetine). It is a serotonin reuptake inhititor / receptor ligand that improves cognition as a property that is in addition to, but not dependent on, its antidepressant properties.
- Scott
Posted by Pontormo on October 21, 2016, at 18:14:05
In reply to Re: SSRI's not good for older people over 50 + TCI + M » Phillipa, posted by SLS on October 18, 2016, at 7:06:01
My question would be about what studies Dr Tahir has done that leads him to this conclusion, as well as what his credentials are for exploring this subject? Is he a psychopharmacologist? a doctor specializing in sleep disorders?
How many patients, what statistical methods did he use? how long did he follow these patients? what suggested to him that this issue was a logical one to pursue?
I'd like to know how valid this study is, how is has been received by others in the field, and whether its results have been followed up or, or duplicated by others who might be asking the same question.
Until I see that, I'd be cautious in reaching any conclusions.
Posted by former poster on November 11, 2016, at 16:02:28
In reply to SSRI's not good for older people over 50 + TCI + M, posted by Phillipa on October 17, 2016, at 18:34:35
If sleep is the issue I can think of one SNRI that improves sleep, Savella.
This is the end of the thread.
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