노인성 우울증에 대한 약물치료지침

Guidelines for the Drug Treatment of Geriatric Depression

The author reviews general principles and guidelines regarding the drug treatment of geriatric depression. Older depressed patients are more prone to drug adverse reactions and drug-drug interactions than younger patients because of pharmacokinetic and pharmacodynamic changes resulting from age-related physiological changes, physical illnesses, polypharmacy, and various other factors. Therefore, a careful evaluation for physical illnesses and drugs needed to be made before strating antidepressant medication and "start low, go slow" dosing principle should be kept in mind. All classes of antidepressants available for younger depressed patients could be used for the geriatric patients. Choice of specific antidepressant drugs depend on potential adverse reactions and interactions of each agent, subtype or severity of depression, and comorbid diseases, such as stroke, dementia, Parkinson's disease, and heart disease. ECT must be also considered for antidepressant-resistant severe geraitric depression.