Medication management in older adults: selecting antidepressants

Medication management in older adults presents unique challenges, due to physiological changes associated with aging and the increased likelihood of comorbid conditions. Age-related changes in drug absorption, metabolism and excretion can significantly affect the pharmacokinetics and pharmacodynamics of medications, leading to an increased risk of adverse drug reactions (Davies et al, 2020). This case study examines the complexities involved in selecting an appropriate antidepressant for an elderly patient with multiple comorbidities, including a recent episode of severe hyponatraemia likely caused by syndrome of inappropriate antidiuretic hormone secretion (SIADH).

The patient is a 78-year-old man with a long-standing history of anxiety and depression, including episodes of suicidal ideation. He has multiple comorbid conditions, including type 2 diabetes mellitus (T2DM), hypertension (HTN), chronic kidney disease (CKD) and a history of myocardial infarction (MI) in 2023.

Over the past year, he has experienced three falls, raising concerns about his stability and safety. Recently, he was admitted to the hospital for severe hyponatraemia (sodium level of 116 mmol/L where normal range is 135 and 145 mmol/L) likely related to SIADH, and is currently under investigation for potential gastrointestinal (GI) cancer.