Depression is a common medical condition that affects all age groups. Most people have a 15 – 30% chance of having a depressive episode at least once in their lifetime. The chances of an elderly person having depression are higher. One of the reasons for this increase in depression comes from the medications that so many elderly people must take. As we age, our bodies lose their ability to tolerate medications.
Specifically, organs that process drugs, such as the liver and kidney, function less efficiently with age.
The following medications/groups of medications have been shown to sometimes cause depression, particularly in the elderly. If these medications are thought to be responsible for depression, a trial off of, or a substitute for the medication may be warranted. In some cases, the medication can be stopped, the dosage may be reduced or a suitable substitute may be tried. In other cases, there may be no other choice but to use an anti-depressant to counteract the effect of the medication.
Narcotic medications like codeine - found in Tylenol #1, 2 and 3 - can cause lethargy and drowsiness and can increase the risk of falls and fractures. Codeine and other narcotics generally decrease moods and, on a long-term basis, may cause depression especially in the elderly. In general, Tylenol (plain or extra strength) is the safest painkiller for the elderly and it also does not appear to have any depressant effects.
B-blockers like propanolol and diuretics (water pills) like Hydrochlorothiazide can cause both sexual disturbance and depressed mood. If it is believed that these medications may be causing depression, other blood pressure medications like Altace or Vasotec can be considered. If a b-blocker must be used, propanolol may be replaced with the b-blocker atenolol, which appears to have a less of a depressant effect than propanolol.
Digoxin and other medications used to lower rapid heart rates (like lidocaine and procainamide) may have depressant effects. In some cases, lowering the dose can still result in the medication being beneficial, but the lower dose results in less of a depressant effect.
Certain eye drops used for glaucoma like timolol have b-blockers in them and can result in depression. Consulting an ophthalmologist to try to change the eye drops may be a good idea since there may be an alternative eye drop available that does not have a depressant effect.
Sleeping pills of the benzodiazapene family (valium, ativan, rivotril, restoril) have a sedating effect but the elderly may not be able to process and “break down” these medications properly. This intolerance can cause the medication to have a prolonged effect resulting in drowsiness and depression.
Sleeping pills should be used very cautiously in the elderly and daily or long-term use should generally be avoided. Over-the-counter antihistamines are sometimes also used as a sleeping aid but can also result in depression if taken on a long-term basis.
Many people are surprised by the fact that some antidepressants can actually cause depression or make an existing depression worse. The elderly tend to respond better to different antidepressants than younger people. For example, elderly people tend to get agitated with antidepressants like Paxil.
Antidepressants that appear to be well tolerated by the elderly include Serzone and Celexa. If someone who is depressed seems to be getting more depressed on a certain antidepressant, a change of their medication should be considered.
Alcohol can be a depressant, particularly in the elderly and especially if more than 1 drink a day is consumed. Alcohol may also interfere with the way antidepressants act and may counteract the beneficial effects of the antidepressant. The alcohol consumption of a depressed person should always be monitored and attempts should be made to limit or moderate alcohol consumption.
