Escitalopram in the treatment of mental disorders in elderly patients

The pharmacotherapy of mental disorders is often difficult in the elderly and might be limited by several factors, including medication side effects, drug-drug interactions as well as psychiatric and somatic comorbidities, which are all more common than in younger patients. These aspects of therapy, together with the multifactorial pathogenesis as well as a well-known increased placebo response, lead to overall lower effectiveness of drug therapies in the elderly. The choice of medication, taking into account its proven efficacy and safety, is therefore a key to a successful treatment. Escitalopram is a promising agent for treating older patients. Its pharmacodynamic selectivity, beneficial pharmacokinetic profile (including a relatively low potential of inducing drug interactions) and relatively rare incidence of severe side effects, together with acceptable efficacy in clinical trials, resulted in its common use for the treatment of mood and anxiety disorders (including those with presumable organic causes) and, recently, as a drug for agitation, aggression and psychosis that accompany dementia of the Alzheimer's type. Additionally, escitalopram is easy to use. A once-daily schedule as well as the availability of a non-tablet formulation (oral drops) is a further advantage, particularly for patients with swallowing difficulties, gastrostomy (enteral nutrition), those who take many medications and for patients with cognitive impairment.