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Antidepressants are a popular treatment choice for depression.Although antidepressants may not cure depression, they can reduce symptoms. But if it doesn't relieve your symptoms or it causes side effects that bother you, you may need to try another.Nonpharmacologic measures, such as cognitive-behavioral therapy, and sleep hygiene (eg, avoiding caffeinated beverages, limiting daytime napping, modifying bedtime) should be tried first.If they are ineffective, nonbenzodiazepine hypnotics (eg, ) are options for short-term use.Sitting and standing BP can be monitored, particularly when multiple antihypertensives are used, to check for orthostatic hypotension, which may increase risk of falls and fractures.Levodopa clearance is reduced in elderly patients, who are also more susceptible to the drug’s adverse effects, particularly orthostatic hypotension and confusion.Once the patient responds, the dose should be titrated down, if possible, to the lowest effective dose. Clinical trial data relating to dosing, efficacy, and safety of these drugs in the elderly are limited.
When an antipsychotic is used, the starting dose should be about one quarter the usual starting adult dose and should be increased gradually with frequent monitoring for response and adverse effects.In nonpsychotic, agitated patients, antipsychotics control symptoms only marginally better than placebo and can have severe adverse effects.In people with dementia, studies showed antipsychotics increased mortality and risk of stroke, leading the FDA to issue a black box warning on their use in such patients.Elderly patients, especially women, are at increased risk of tardive dyskinesia, which is often irreversible.Sedation, orthostatic hypotension, anticholinergic effects, and akathisia (subjective motor restlessness) can occur in up to 20% of elderly patients taking an antipsychotic, and drug-induced parkinsonism can persist for up to 6 to 9 mo after the drug is stopped. Risks and benefits of using an antipsychotic should be discussed with the patient or the person responsible for the patient's care.