The effects of antidepressants SSRIs (serotonin specific reuptake inhibitors), TCAs (tricyclic antidepressants) and SNRIs (serotonin-norepinephrine reuptake inhibitors), in particular, are unknown. Rationale: The effects of antidepressants on mood, cognition and the daily activities of Alzheimer patients are ambiguous. The comprehensive geriatric assessment has its place in decision support during the potentially iatrogenic prescriptions of drugs such as psychotropic and new tools such as STOPP/START can also be a help to the prescriber informed. The Mini Mental State Examination (MMSE) was the tool that has most influenced the changes in psychotropic including a tendency to increase and the introduction of anxiolytics when MMSE < 20 (p = 0.007) while neuroleptics instead arrested and decreased (p = 0.012).
We compared these changes according to the comprehensive geriatric assessment tools and we analyzed the changes based on lists of potentially inappropriate medications by Laroche et al. Our prospective study of four months in 100 patients aged 75 years and older hospitalized in the Geriatric Internal Medecine Departement of University Hospital of Nice investigated what were the clinical or biological reasons and tools used during changes of psychotropic drugs. We wanted to know if the tools of the comprehensive geriatric assessment or other factors could influence the changes of psychotropic drugs in a geriatric departement. Some medications such as psychotropic drugs are particularly involved in iatrogenic accidents.
Nearly half of iatrogenic drug in the elderly are preventable. The elderly often with multiple diseases are particularly at risk from adverse drug reactions. It is necessary to assess the effectiveness and adverse effects of antidepressants in demented elderly subjects through several studies. Among the drugs frequently used in studies in order to evaluate these indications, citalopram and moclobemide are those associated with a low risk of adverse events and a significant effectiveness on depression signs and behavioural and BPSD. At present, there is a lack of data to assess the benefit–risk ratio of antidepressants in the treatment of depression and BPSD in patients with Alzheimer's disease or other dementias. As they are used in clinical practice, selective serotonin reuptake inhibitors, which initially appeared to have low risks, have been associated with many and dangerous adverse effects, particularly in elderly subjects. Indeed, most studies have included patients aged at least 65 years without frailty criteria, but rarely those aged over 75 years and/or frail. Physicians should be particularly careful in the use of antidepressants in the elderly, particularly in the frail elderly. Depression and behavioural and psychological symptoms of dementia (BPSD) have a significant impact on the worsening of dementia because they increase the cognitive and functional decline and they have a significant impact on the vital prognosis.
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