category: Medical science

Citalopram: use in elderly patients



The prevalence of depressive disorders in the elderly is estimated at 12-15% [1]. Estimated psihiatricheskogosoyuza number of geriatric patients with depression in this age group in the United States is approaching 6 million [2].

In a survey in 1070 randomly selected people aged 65 years and older, residing in Liverpool (England), found chtorasprostranennost clinical cases of depression was 11.3% more in 10.7% of cases observed subsyndromal disorder [3]. Most depression patients upozhilyh awarded less than a secondary or minor depression. As reported, the rate of minor depression is 50% [1, 4, 5].

The probability of early relapse after the first depressive episode increases with age [6, 7]. The probability of full vyzdorovlenieposle episode of major depression in old age is reduced, and residual symptoms may persist even with a decrease in its degree [8].

According to available data, with 40-50% of patients with Alzheimer's disease revealed signs of depressed mood, and at 10-20% - tekuschiedepressivnye disorder clinically significant [9]. Reifler et al. [10] found concomitant depression in approximately 25% of the 103 geriatricheskihambulatornyh patients with dementia (by DSM-III). In a subsequent study Reifler et al. [11] found that 31% of 131 patients (mean age 77let) with dementia, Alzheimer's type meet the criteria for DSM-III major depressive disorder during the initial survey. Pozhilyebolnye with certain physical illnesses such as cancer, vascular lesions of the CNS and Parkinson's disease, reveal great rasprostranennostbolshoy and minor depression than the others under consideration of age [12-14].

Unfortunately, the use of antidepressants in this vozrastnoygruppe been studied in only a few controlled clinical studies. As a result, guidance on the use of antidepressants in elderly litsekstrapoliruyutsya data originally obtained in patients with depressed youth and middle age [16].

Not enough to complete the identification, incorrect diagnosis and treatment of depression in old age - the rule rather than the exception [2, 17,18]. One reason for this lies in the fact that depression is often masked by or triggered by comorbid physical illness, medikamentoznymisredstvami or alcohol [1]. For example, depression is often "browsing" in elderly patients with cognitive disorders [1, 2, 10]. Perhaps takiebolnye simply can not give a precise histories of information [18]. In elderly patients with depression, likely difficulties with recognition iopisaniem own depressive symptoms [19], while they may experience fear that they have diagnosed with senile dementia, if onipozhaluyutsya to slow thinking and memory impairment. In general they are more likely to report somatic rather than psychological symptoms [17, 18]. Pozhilyebolnye, their family members and even some doctors may treat depression as a normal manifestation of aging or a normal reaction namnogochislennye loss is associated with aging (eg, death of loved ones, loss of work).

At present, significantly increased the popularity of the use of selective serotonin reuptake inhibitors (SSRIs) prilechenii depression in old age. This is because this class of antidepressants cause fewer adverse and sometimes opasnyhpobochnyh effects inherent to tricyclic antidepressants (TCA), including anticholinergic effects associated with urinary retention, constipation, confusion, as well as cardiotoxicity, orthostatic hypotension, a potentially lethal when overdose [19]. Among SIOZStsitalopram - especially attractive antidepressant for elderly patients with depression. It was first licensed for use in Denmark in 1989, and Data are now categorized it is one of the most widely used antidepressants in most European countries and the USA.

This publication is a review of studies of the pharmacological profile, efficacy, safety and perenosimostitsitaloprama, as well as several works that deal specifically with the use of antidepressants in elderly patients with depression.

Pharmacodynamic and pharmacokinetic features

Himicheskayastruktura citalopram, a bicyclic derivative izobenzofurana has no analogues among the other antidepressants. Powerful and the most selective of vsehimeyuschihsya currently SSRI citalopram has almost no effect on noradrenaline, dopamine and GABA, as well as the receptors drugihneyromediatorov. Because the main metabolites of citalopram have the same selectivity and are found in blood plasma in low concentrations, oniprakticheski not affect the biochemical activity of citalopram [22, 23, 27, 28].

Weak affinity of citalopram for other receptors (histamine, acetylcholine, dopamine, alpha-adrenoceptors and others) and enzymatic systems distinguishes this drug from the tricyclic antidepressants and, in some mensheystepeni from other SSRIs [25]. This feature explains why antidepressant seen virtually no causing ikardiotoksicheskih anticholinergic side effects typical of tricyclic antidepressants [23].

The results of pharmacokinetic studies with citalopram 8zdorovyh subjects aged 23 to 34 years demonstrate that the antidepressant is absorbed rapidly and almost completely, regardless of priemapischi. High bioavailability (average 80%), citalopram suggests that the first pass metabolism by the drug is limited. After oral administration of 50 mg of antidepressant priemabolnymi its maximum plasma concentration is achieved within 2-4 h. In most patients, with regular peroralnomprieme its stable drug concentration in plasma was set within 1-2 weeks. This concentration was linearly related to the dosage used [27, 32]. Such a direct relationship reduces the risk of potentially possible disproportionate changes in the properties of antidepressant-related kolebaniyamiego concentration, which in turn may be due to inhibition of serotonin reuptake or by interaction with specific enzymes, cytochrome P-450 (TSTH) [33].

Efficacy in elderly patients

Although data on the effectiveness of citalopram and other SSRIs in the treatment of depression and drugihemotsionalnyh disorders in young patients is very extensive, data on the clinical activity of these antidepressants in the elderly are limited [34]. Vskandinavskom study Nyth and Gottfries [35], performed in 1990, researchers used a combination technique (double-blind and open), to compare the results of treatment with citalopram and placebo symptoms of dementia in elderly patients. This study was not developed specifically for otsenkieffektivnosti SSRIs for depression, but the results of the initial testing of patients with depression rating scale assistance Montgomery Asberga (MADRS) show that the majority of the surveyed noted symptoms of mild depression. Studied the effectiveness of treatment 89 patients (average age 77.6 years) Alzheimer's disease, moderate flow, senile dementia, Alzheimer's type or vascular dementia. Patients with severe dementsieyv study were not included. The severity of mental pathology was evaluated using Clinical Global Impression scale (CGI), and symptoms uhudsheniyaili improvement - through Geriatric evaluation scale Gottfries-Brane-Steen (GBS) and MADRS. In general, the results indicate that after 4-week course of treatment for patients with Alzheimer's disease or senile dementia Alzheimer's type citalopram (n = 31) okazalsyaznachitelno more effective than placebo (n = 45), contributing to the reduction of depressed mood (p

In 1992 Nyth et al. [36] compared the effectiveness of citalopram in doses of 20 and 30 mg daily with placebo in the treatment of emotsionalnyhrasstroystv patients with a clinical diagnosis of depression, whose age ranged from 65 to 91 years. In this 6-week mnogotsentrovomissledovanii that occurred in Scandinavia, double-blind, 98 (74%) of 133 patients with major depression and 29 (22%) - and even dementia. Improving the background of citalopram (n = 88) was more pronounced than in the comparison group (n = 45). Differences in average total Ballou Hamilton Depression Scale (HDRS) istepeni of the reduction was statistically significant (p

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