The treatment of depressed demented patients

Problems in diagnosing depression and unclear pharmacologic guidelines may reduce the use and efficacy of antidepressant treatment in depressed demented patients. Data from the few controlled studies involving patients with depression and dementia suggest that tricyclic antidepressants improved depressive symptomatology in more than 50% of patients. However, comparable improvement has been reported with placebo. Cognitive dysfunction in elderly patients with depression appears to alter tricyclic plasma concentration-efficacy relationships. Enlargement of lateral brain ventricles may be associated with poor response to tricyclics as well as altered plasma concentration-efficacy relationships. There is some evidence that nontricyclic antidepressants may be effective in demented patients with depression. An emerging pharmacology for cerebrovascular disease may have relevance in treating and preventing several geriatric depressive syndromes, but specific studies are needed.