References

Davies LE, Spiers G, Kingston A, Todd A, Adamson J, Hanratty B Adverse Outcomes of Polypharmacy in Older People: Systematic Review of Reviews. J Am Med Dir Assoc. 2020; 21:(2)181-187 https://doi.org/10.1016/j.jamda.2019.10.022

Giovannini S, Brau F, Galluzzo V Falls among older adults: screening, identification, rehabilitation, and management. Applied Sciences. 2022; 12:(15) https://doi.org/10.3390/app12157934

Mazzoglio y Nabar MJ, Muñiz M, Montivero CA, Schraier G, Leidi Terren EE Hyponatremia secondary treatment with SSRI antidepressants in adults and elderly. CNS Spectrums. 2022; 27:243-244 https://doi.org/10.1017/S1092852922000505

Nagashima T, Hayakawa T, Akimoto H, Minagawa K, Takahashi Y, Asai S Identifying Antidepressants Less Likely to Cause Hyponatremia: Triangulation of Retrospective Cohort, Disproportionality, and Pharmacodynamic Studies. Clin Pharmacol Ther. 2022; 111:(6)1258-1267 https://doi.org/10.1002/cpt.2573

Medication management in older adults: selecting antidepressants

02 January 2025
Volume 7 · Issue 1

Abstract

Medication management in older adults presents unique challenges due to age-related physiological changes and increased comorbidities. This case study explores the selection of an appropriate antidepressant for an elderly male with multiple comorbid conditions and a recent episode of severe hyponatraemia likely caused by syndrome of inappropriate antidiuretic hormone secretion (SIADH). Considering the patient's history of intolerance to mirtazapine and the risk of hyponatraemia with SSRIs, mianserin is recommended. A comprehensive monitoring and management plan is outlined to address hyponatraemia, falls risk, diabetes management, hypertension and chronic kidney disease.

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.

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