In elderly patients with depression, antidepressant selection should be guided by the patient's tolerance for cardiovascular and anticholinergic side effects.
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Tolerability should guide antidepressant selection in elderly patients; this review leaves open net cardiovascular advantages of second-generation agents.
The pharmacologic treatment of depression in the elderly is often complicated by cardiovascular disease and other medical illnesses. Both the tricyclic antidepressants and the monoamine oxidase (MAO) inhibitors have adverse effects that are potentially dangerous in this age group. Second generation antidepressants may have fewer cardiovascular and anticholinergic side effects, but many do not offer any real advantage over the older drugs. In practical terms, the choice of antidepressants for use in elderly patients will be based largely on their degree of tolerance for unwanted effects.
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Peabody et al. (1986) studied this question.
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