For mental health professionals, one of the most common and frustrating challenges is matching people who have depression with the most appropriate antidepressant medication. Every case is unique, and the variables that factor into each decision are numerous. All too often, physicians resort to a trial-and-error approach, which at best results in delayed outcomes for the person taking the medication. At worst, the person will become frustrated and end treatment early.
In the geriatric population, the problem of selecting the right antidepressant medication is especially pressing. Elderly people are far more likely to be unresponsive to psychotropic medications. In many cases, comorbid psychological conditions or poor physical health add to the problem of treating elderly depression. For these reasons and more, getting the medication right the first time takes on a greater-than-ordinary level of urgency.
Recently, there have been several studies on the possibility of identifying potential biological markers that can assist in the selection of antidepressant medications. In one such study, elderly individuals with depression underwent magnetic resonance imaging. Researchers were interested in the metabolism rate of glucose in various regions of the brain. These same individuals were then given a single intravenous dose of Celexa (citalopram) and scanned once more. Afterward, each individual was placed on a 12-week regimen of either placebo or Celexa and assessed for depressive symptoms.
The results of this study were significant: People with lower rates of cerebral glucose metabolism responded more positively to both Celexa and cognitive therapy. Previous studies have suggested that high cerebral glucose metabolism correlates with high anxiety and more profound depression, especially in the elderly.
Magnetic resonance imaging and neurochemical profiles are not practical for use by an attending physician during the medication selection process. However, the findings of this study and others like it are paving a way toward more straightforward tests for probable responsiveness to certain medications. Celexa is a particularly good choice for the elderly, as the side-effect profile is not as worrisome as many other such medications.
If these individuals can be identified from the early stages of treatment as good candidates for Celexa, their outcomes will definitely improve. The isolation of important biological markers will take out much of the guesswork involved in mental health care. Once identified, predictive biological markers will enable physicians to choose the proper medication for each individual, without having to switch medications weeks later.
- Citalopram – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001041/
- Smith, G.S., Workman, C.I., Kramer, E., Hermann, C.R., Ginsberg, R., Yilong, M., Dhawan, V., et al. (2011). The relationship between the acute cerebral metabolic response to citalopram and chronic citalopram treatment outcome. American Journal of Geriatric Psych, 19, (1), 53-63.
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