Among the elderly, depression is one of the most common mental health issues. Declining cognitive abilities, reduced independence, and chronic illness often combine to place this population in the high-risk category for mental health problems. Adding to the difficulty of treating this population is the fact that elderly individuals often don’t respond well to first-line treatments for depression.
Part of the reason for this is that antidepressant medications are sometimes metabolized differently in elderly individuals. When a chronic illness is present, medication metabolism may be further altered. An experiment in Italy recently tested whether chronic heart failure might cause an altered metabolism of a specific antidepressant.
The antidepressant medication Luvox (fluvoxamine) is a first choice for treating depression, in both young and elderly people. It belongs to the class of drugs known as selective serotonin reuptake inhibitors. Years of data have confirmed that these medications are both safe and effective, with few serious side effects. However, little data exist as to how Luvox breaks down in the body of an elderly person, much less an elderly person with a chronic health issue. The prevalence of depression in the elderly population clearly argues for more rigorous research.
In the Italian study, 30 volunteers were recruited from an outpatient facility. Ten healthy young men, 10 healthy elderly men, and 10 elderly men with chronic heart failure participated. After a night of fasting, each was given a single dose of Luvox and monitored for changes to vital signs. Blood samples were collected at regular intervals and later analyzed. Because of potential risks, only one dose was given to each participant. Researchers were interested to see what concentration Luvox reached in blood plasma and how long before the body eliminated the drug. Each participant was given an equivalent dose of the medication and asked to report any side effects.
Not surprisingly, blood plasma concentrations of Luvox reached higher levels in the elderly men and took longer to dissipate. Decreased organ function in general accounts for this difference. As a consequence, dosages of Luvox for elderly patients are roughly half those of younger patients. Researchers were intrigued to learn that a condition of chronic heart failure had no significant effect on Luvox metabolism or blood plasma levels. They had theorized that poor cardiac function would further impair drug metabolism, but for Luvox that appears not to be the case. Because of the small sample size and the single-dose experimental design, further study is definitely needed.
References:
- PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluvoxamine. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000955/
- Orlando, R., De Martin, S., Andrighetto, L., Floreani, M., Palatini, P. (2010). Fluvoxamine pharmacokinetics in healthy elderly subjects and elderly patients with chronic heart failure. British Journal of Clinical Pharmacology, 69(3), 279-286.
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