Elderly at greater risk with the new antidepressants

The new generation of antidepressants such as the selective serotonin reuptake inhibitors (SSRIs) may be more dangerous than their predecessors for the elderly, the most common group of users.

So dangerous can they be that the newer drugs should be avoided in older people whose medication is not supervised, argue two senior doctors at a Glasgow hospital.

The SSRIs are becoming the first treatment of choice for depression in the elderly, partly because they are believed to be more effective and also because they are supposed to be safer.

It is true that some of the tricyclic antidepressants the generation that preceded the new SSRIs can also be dangerous, say Martin and Hilary Livingston from the Southern General Hospital. Amitriptyline and dothiepin in particular can kill if the patient takes an overdose, always a possibility in older people, they say.

But to suggest from this that all tricyclics are more dangerous than their SSRI counterparts is a claim not supported by the evidence.

The only SSRI that has any track record of safety is paroxetine which, along with sertraline, seems to be as good as but not better than the older generation of drugs. Of the other SSRIs, citalopram, moclobemide and probably fluoxetine (Prozac) are better than placebo.

And as to their safety the jury's still out (BMJ, 1999; 318: 1640-1).