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Published on: May 9, 2012
by STL Today
Newer antidepressants have long been considered “effective and safe.” These antidepressants include escitalopram, citalopram, sertraline, paroxetine, and fluoxetine, commonly known by their old trade names Lexapro, Celexa, Zoloft, Paxil, and Prozac. They are approved to treat clinical depression and various anxiety disorders, including generalized anxiety disorder (worrying too much), panic disorder, post-traumatic stress disorder and obsessive-compulsive disorder.
Recently, some have questioned whether they are effective, or safe, particularly in older adults. One summary of several clinical trials asserted that these antidepressants are no better than placebos, except in the most severe patients. Additionally, some observational studies have linked these antidepressants to falls and bone loss in older adults. These studies tend to get a lot of media attention.
What’s an older adult to do with this information? First, numerous clinical trials have demonstrated that antidepressants work — that is, they reduce symptoms of depression and anxiety disorders. How well they work and in whom — these are not questions that clinical trials in mental health can usually answer.
In fact, thousands of clinical trials have taught us only a few things about antidepressants. First, they reduce the time it takes patients to improve from a severe clinical depression or anxiety disorder. Second, if they help patients get well, they also help patients stay well — if they stay on the medication at the same dose. Third, one antidepressant will not work for everyone, and people sometimes need more than one medication. Some ongoing clinical trials are better designed to answer the important question of whom benefits most from treatment.
Yet psychiatrists can help most of their patients with depression and anxiety disorders. A good psychiatrist will ask you about your symptoms and whether they’ve improved and then adjust the treatment based on your report of any improvement as well as side effects. Most patients get better if their psychiatrist is able to find the best dose, maintain a medication when it works, augment it with another medication (and/or psychotherapy) when it works but not enough or switch it when it doesn’t work. For older adults suffering from depression or anxiety disorders, my main recommendation is to find a geriatric psychiatrist and/or a psychologist who does talk therapy with older adults.
What about risks? Side effects, if they occur at all, happen early in treatment and go away as the body adjusts to the medication. They are not reasons to stop treatment. It is still unknown whether falls and bone loss result from antidepressants. I believe that research will eventually solve these questions.
Until then, I would recommend that those with mild symptoms of depression or anxiety are probably better off with talk therapy or self-help (self-help books, exercise, meditation increased physical and social activity). For those with more severe symptoms, the benefits of antidepressants outweigh any theoretical risks. Someone taking an antidepressant and still suffering from depression or anxiety or having unwanted side effects should talk to his or her doctor.
Patients who have had a severe, chronic depression or anxiety disorder and have gotten well with antidepressants should stay on the antidepressant, or at least not stop it without talking to their prescribing doctor.
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