17,36 In one placebo-controlled trial in the elderly, although bupropion was effective, it was no more so than imipramine.36 Older placebo-controlled trials showed mixed results.37,38 In younger patients, it may cause seizures at high doses

and should be given in divided doses. Since clinical trials have excluded Inhibitors,research,lifescience,medical patients with cardiovascular disorders, bupropion’s apparent margin of safety would not necessarily be applicable to elderly patients with concomitant cardiovascular disease.36 Venlafaxine inhibits the reuptake of both serotonin and norepinephrine. It is underresearched in elderly patients and its role for the treatment of depression in late life is uncertain. In clinical trials performed for the Food and Drug Administration’s Inhibitors,research,lifescience,medical (FDA) registration purposes, elderly patients comprised only 229 out of 2000 patients who received venlafaxine and only a relatively small number of these were administered the drug for more than 1 year. Nevertheless, data from the small subset receiving long-term treatment suggest that tolerability is equivalent to that in younger patients. A trial of venlafaxine

could be considered in elderly patients who do not adequately respond to other drug modalities. Venlafaxine has a wide dosage Inhibitors,research,lifescience,medical range of 75 to 350 mg/day, administered Inhibitors,research,lifescience,medical in divided doses twice or three times daily As with SSRIs, PXD101 in vivo headache, insomnia, and nausea are among the more frequent side effects. Other relatively common reactions include somnolence, dry mouth, dizziness, sweating, and nervousness. Venlafaxine has caused sustained, dose-related Inhibitors,research,lifescience,medical increases in systolic blood pressure and diastolic blood pressure, and heart rate (1.1 to 4.5 beats/min).39,40 Although its effects on blood pressure are not likely to be of clinical

importance in an otherwise healthy depressed patient, blood pressure monitoring is needed in patients with preexisting cardiovascular disease or in those receiving relatively high dosages. Recently, a sustained-release preparation has become available that may lessen some of these effects. Nefazodone is another agent with little published clinical research in the elderly population, although clinical trials have been old performed in the elderly, and it thus has an undefined role in the treatment of late-life depression. It has a dosage range of 300 to 500 mg/day, which is administered in divided doses, twice daily. Although associated with dose-related cognitive and psychomotor effects, the drug seems to be relatively well tolerated and relatively safe in overdosage. Ideally, the pharmaceutical company will release results of their trials.