Pharmacotherapy (Medication Treatment) for Depression in Older Adults

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Medication Treatment for Depression in Older Adults – Key Points
What are antidepressants?
How can antidepressants help me?
How do I get antidepressants?
How much do I have to take and for how long?
Do antidepressants work?
How do I know if antidepressants are right for me?
What are the side effects of antidepressants?
Are there things to consider if I am taking other medications?
What if I don’t think I will be able to stick to this treatment?
How much do antidepressants cost?

Key Points

  • Medications taken for depression are called antidepressants.
  • Antidepressants work for treating moderate to severe depression for adults of all ages. There are some unique things for older adults to think about when choosing an antidepressant medication.
  • Antidepressants will affect each person differently. Your family doctor or mental health professional can help you decide if antidepressants are right for you.

What are antidepressants?

  • Many people, including older adults, take medicine to improve their depression symptoms. Medicine for depression in older adults is most commonly recommended when:
    • Depression symptoms are in the moderate to severe range
    • Antidepressant medication has been used in the past and has worked
    • Other treatment options for depression did not work or are not accessible

How can antidepressants help me?

  • Some research shows that severe depression is rooted in communication changes and challenges within the brain. By regulating this brain-based communication with chemical messengers (neurotransmitters), symptoms of depression can improve.
  • Antidepressants correct these chemical messages (neurotransmitters) in parts of the brain that have to do with mood, emotions, and motivation.
  • Each type of antidepressant works differently, but all have an impact on the chemicals in your brain that affect your mood and feelings.
  • Each person may react differently to antidepressant medications.
  • When antidepressants are working for older adults experiencing depression, they might notice that their mood gets better, they have more energy and interest in activities, and they can think more clearly.
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How do I get antidepressants?

  • Your family doctor will usually be the first person you go to, to talk about antidepressant medication.
  • Depending on your situation, your family doctor may recommend you see a psychiatrist. A psychiatrist is a doctor who specializes in mental health and can prescribe antidepressants.

How much do I have to take and for how long?

  • A common approach to treating depression in older adults with antidepressants is to “start low and go slow.” Your doctor will likely start you on a low dose. Dosage adjustments may then be made later on.
  • It may take you and your doctor time to find the right dose. Everyone responds differently, and it is difficult to know what will work best for you. Small changes are often noticed by a person or by a loved one within 2-3 weeks. It may take up to 12 weeks (or longer) to notice any differences in how you feel.
  • Taking your medication regularly and as recommended is important. You should do your best to stick to your medication schedule.
  • Some tricks that help people stick to a medication schedule include using weekly pill boxes, using electronic pill reminders or calendar alerts, and taking medication at the same time as doing another regular daily activity, like breakfast or getting ready for bed.
  • People who stick with their medication and continue to take it as recommended usually have better outcomes.
  • If you are thinking about stopping your antidepressants, make sure to talk to your doctor. Antidepressants need to be stopped slowly. Stopping suddenly can be very harmful to you.
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Do antidepressants work?

  • Most antidepressants work about the same for treating moderate to severe depression in older adults and differences between them are small.
  • There is no single treatment that works for everyone. How well a person responds to an antidepressant medication is different from person to person and can depend on many factors.
  • It can take time to find a medication that works for you. Start with one that you are comfortable with and work closely with your doctor until you find one that works best for you. This can sometimes take time and patience.
  • Be sure to pay attention to yourself and monitor your mood, energy levels, and activities while you are taking antidepressants. Discuss what you notice with your healthcare provider.
  • Remember that taking medication for depression will not make you happy all of the time.
  • Other types of treatment may also help to reduce your stress levels or help you cope with difficulties in your life.
  • Combined medication and psychotherapy may be more effective than either treatment alone in some situations.
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How do I know if antidepressants are right for me?

  • Deciding what treatment(s) are for you can be hard. Here are a few points to consider if you are thinking about an antidepressant medication:
    • the possible side effects
    • whether antidepressants will interact with other medications you are taking
    • whether you are able to take the antidepressants as prescribed by your doctor (stick to schedule)
    • how severe your depression is when you seek treatment
    • whether you are interested in other treatments instead of or in addition to antidepressant medication

What are the side effects of antidepressants?

  • Sometimes, when you start taking an antidepressant, you may notice some side effects. Not everyone responds the same and it can be difficult to know whether you will experience side effects or not.
  • Many people do not notice any side effects when starting an antidepressant. Starting with a low dose is helpful in reducing side effects. Taking your antidepressant with or just after meals will also help to reduce side effects.
  • Common side effects reported by people taking antidepressants include: nausea, constipation, dizziness, headaches, insomnia or difficulty with sleep, drowsiness, dry mouth, and sexual dysfunction.
  • Not everyone experiences side effects and not much is known specifically about side effects in older adults.
  • Make sure to closely watch how you feel and write down any side effects that you notice when you are taking antidepressants. If you notice side effects that bother you, talk to your healthcare provider immediately.
  • It’s important to keep track of your side effects and what your healthcare provider recommends doing about them.
  • Some of the common side effects such as headaches and nausea usually go away a short while after starting an antidepressant. Others re-experience these side effects when doses are increased (but they usually go away again).
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Are there things to consider if I am taking other medications?

  • Many people take medications for different health issues, such as heart problems, sleep problems, and anxiety, among others. Combining other medications with antidepressants can make the antidepressants not work as well or can have other harmful effects. It is important to talk with your doctor about possible drug interactions.
  • Common medications or substances that may interact with your antidepressants include:
    • sleeping pills
    • benzodiazepines
    • aspirin
    • beta blockers
    • alcohol
  • Be sure to talk to your doctor about any health issues that you have, or medications you are already taking.
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What if I don’t think I will be able to stick to this treatment?

  • It is important to take antidepressants regularly and as prescribed, but this can be difficult for some people. For example, some people may be bothered by side effects or may forget.
  • Some research also shows that people with severe depression respond better to antidepressants than those with mild or moderate depression.
  • If you feel that you may have a difficult time sticking with your antidepressant treatment or schedule, or if your healthcare provider determines that your depression is less severe, this treatment may not be the best option for you.
  • Talk with your healthcare provider about your experience with treatment and other treatments that might work for you.
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How much do antidepressants cost?

  • The cost of antidepressants varies based on dose and brand. A 1-month supply of commonly prescribed antidepressants can range from $30 – $200.
  • Provincial health plans do not usually cover the full cost of prescription drugs, including antidepressants.
  • In Manitoba, Pharmacare is a drug benefit program based on income that can help some people pay for or offset the cost of certain medications: https://www.gov.mb.ca/health/pharmacare/
  • If you have group or private insurance, like Blue Cross, your prescription for antidepressants may be covered in full or in part.
  • Talk to your doctor, pharmacist or insurance provider to see what your options are for paying for or offsetting the cost of antidepressants.
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References

  • Cleare, A., Pariante, C., Young, A., Anderson, I., Christmas, D., Cowen, P., … Uher, R. (2015). Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology, 29(5), 459-525. doi: 10.1177/0269881115581093
  • Kennedy, S., Lam, R., McIntyre, R., Tourjman, S., Bhat, B., Blier, P., … Uher, R. (2016). Canadian Network for Mood and Anxiety Disorders (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 3. Pharmacological treatments. The Canadian Journal of Psychiatry, 61(9), 540-560. doi: 10.1177/0706743716659417
  • Locher, C., Kossowsky, J., Gaab, J., Krisch, I., Bain, P., & Krummenacher, P. (2015). Moderation of antidepressant and placebo outcomes by baseline severity in late-life depression: A systematic review and meta-analysis. Journal of Affective Disorders, 181, 50-60. doi: 10.1016/j.jad.2015.03.062
  • Tham, A., Jonsson, U., Andersson, G., Soderlund, A., Allard, P., & Bertilsson, G. (2016). Efficacy and tolerability of antidepressants in people aged 65 years or older with major depressive disorder- A systematic review and meta-analysis. Journal of Affective Disorders, 205, 1-12. doi: 10.1016/j.jad.2016.06.013
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Disclaimer: Information in this pamphlet is offered ‘as is’ and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.

For More Information See:

Download: Fact Sheet: Pharmacotherapy (Medication Treatment) for Depression in Older Adults

Last Updated: May 2020