ABSTRACT Background: Management of acute mania in older adults is challenging due to multiple medical comorbidities and age-related changes affecting drug safety and tolerability. Although lithium and sodium valproate are standard treatments, their use in later life is often limited by renal, metabolic, and bone-related concerns. Endoxifen has recently emerged as a potential antimanic agent with favorable tolerability in young adults, but evidence in older populations is scarce. Methodology: We conducted a clinical audit of case records of nine older adults with mania who received adjunctive endoxifen and had at least one follow-up visit. All patients underwent systematic clinical evaluation using standardized rating scales, including the Young Mania Rating Scale (YMRS). Anonymized demographic, clinical, and biochemical-radiological data, along with treatment response and adverse events, were extracted and recorded using a predesigned data collection sheet. Results: This audit included the case records of 9 older adults (8 males), with an age range of 61–92 years, who were on adjunctive endoxifen. On follow-up, the change in YMRS observed was from 30.76% to 92%; similar trends were observed in the subjective improvement of symptoms as well. All the cases had at least one or more medical morbidities. There were no significant adverse events observed that necessitated the cessation of the medication during treatment. Conclusion: Adjunctive endoxifen can be an effective and safe treatment option for older adults experiencing manic symptoms with coexisting multimorbidity and polypharmacy in complex clinical situations where conventional mood stabilizers pose tolerability or safety concerns.
Kumar et al. (Thu,) studied this question.