- Dedication
- Contributors
- Preface
- 1 A National Institute of Mental Health Perspective on Geriatric Mood Disorder Research
- 2 Research Priorities in Late-Life Mood Disorders
- 3 Epidemiology of Late-Life Mood Disorders
- 4 Public Health Burden of Late-Life Mood Disorders
- 5 Late-Onset Mood Disorders
- 6the diagnosis and treatment of unipolar depression in late life
- 7 Bipolar Disorder
- 8 Non-Major Depression
- 9 Anxious Depression
- 10 The Social Determinants of Depression in Older Adulthood
- 11 Depression in Dementia
- 12 The Challenge of Suicide Prevention in Later Life
- 13 Bereavement and Complicated Grief in Older Adults
- 14 Current Issues in Informal Caregiving Research
- 15 Post-Stroke Depression and Vascular Depression
- 16 Depression and Medical Illness in Late Life
- 17 Comorbid Neurological Illness
- 18 Substance Abuse Comorbidity
- 19 Comorbid Pain Disorders
- 20 Bidirectional Relationships Between Sleep, Insomnia, and Depression
- 21 Use of Adjunctive Therapy in Older Depressed Adults Who are Resistant to Antidepressant Treatment
- 22 Psychotherapy
- 23 Electroconvulsive Therapy and Neuromodulation in the Treatment of Late-Life Mood Disorders
- 24 Complementary and Alternative Medicine Approaches for Treatment and Prevention of Late-Life Mood Disorders
- 25 Prevention of Depression in Later Life
- 26 Depression Medication Treatment Adherence in Later Life
- 27 Depression in Long-Term Care
- 28 Late-Life Depression in the Primary Care Setting
- 29 Depression in Older Adults Receiving Hospice Care
- 30 Late-Life Mood Disorders and Home-Based Services and Interventions
- 31 Novel Platforms for Care Delivery
- 32 Structural Neuroimaging in Late-Life Mood Disorders
- 33 Molecular Imaging in Late-Life Depression
- 34 Functional Neuroimaging in Late-Life Mood Disorders
- 35 Cognitive Biomarkers in Depression
- 36 Neuropathological Markers in Late-Life Depression
- 37 Pharmacogenetics of Late-Life Depression
- 38 Pharmacokinetics and Pharmacodynamics in Late Life
- 39 Psychoneuroimmunology of Depressive Disorders
- 40 The Hpa Axis and Late-Life Depression
- 41 Clinical Prediction Models
- 42 Integration of Biological, Clinical, and Psychosocial Predictors of Treatment Response Variability in Late-Life Depression
- 43 Conclusion
- Index
(p. 655) Pharmacokinetics and Pharmacodynamics in Late Life
- Chapter:
- (p. 655) Pharmacokinetics and Pharmacodynamics in Late Life
- Author(s):
Kristin L. Bigos
, Robert R. Bies
, and Bruce G. Pollock
- DOI:
- 10.1093/med/9780199796816.003.0038
Older patients are the major recipients of drugs, however most research during drug development is conducted in healthy younger adults. Adverse drug events are common in older adults, but are often preventable. Safe and effective drug therapy requires an understanding of both drug disposition and response in older individuals. Geriatric patients are a heterogeneous population, which is evident in the highly variable drug concentrations and differences in dose-concentration-response relationships. While there is a paucity of data regarding the age-related changes in pharmacokinetic differences in antidepressants, there is increasing evidence that the clearance of some drugs decreases with aging and therefore older patients may experience greater concentrations than younger patients at the same dose. Combined with the fact that older adults seem to be more sensitive than younger patients to adverse effects of antidepressants at lower concentrations, it is critical to control for differences in drug exposure. This chapter reviews the current data on the pharmacokinetics and pharmacodynamics of antidepressants, as well as benzodiazepines, mood stabilizers, and antipsychotics, focusing on differences in age-related changes in drug clearance and drug response, as well as side effects and drug interactions that are more prevalent in older adults.
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- Dedication
- Contributors
- Preface
- 1 A National Institute of Mental Health Perspective on Geriatric Mood Disorder Research
- 2 Research Priorities in Late-Life Mood Disorders
- 3 Epidemiology of Late-Life Mood Disorders
- 4 Public Health Burden of Late-Life Mood Disorders
- 5 Late-Onset Mood Disorders
- 6the diagnosis and treatment of unipolar depression in late life
- 7 Bipolar Disorder
- 8 Non-Major Depression
- 9 Anxious Depression
- 10 The Social Determinants of Depression in Older Adulthood
- 11 Depression in Dementia
- 12 The Challenge of Suicide Prevention in Later Life
- 13 Bereavement and Complicated Grief in Older Adults
- 14 Current Issues in Informal Caregiving Research
- 15 Post-Stroke Depression and Vascular Depression
- 16 Depression and Medical Illness in Late Life
- 17 Comorbid Neurological Illness
- 18 Substance Abuse Comorbidity
- 19 Comorbid Pain Disorders
- 20 Bidirectional Relationships Between Sleep, Insomnia, and Depression
- 21 Use of Adjunctive Therapy in Older Depressed Adults Who are Resistant to Antidepressant Treatment
- 22 Psychotherapy
- 23 Electroconvulsive Therapy and Neuromodulation in the Treatment of Late-Life Mood Disorders
- 24 Complementary and Alternative Medicine Approaches for Treatment and Prevention of Late-Life Mood Disorders
- 25 Prevention of Depression in Later Life
- 26 Depression Medication Treatment Adherence in Later Life
- 27 Depression in Long-Term Care
- 28 Late-Life Depression in the Primary Care Setting
- 29 Depression in Older Adults Receiving Hospice Care
- 30 Late-Life Mood Disorders and Home-Based Services and Interventions
- 31 Novel Platforms for Care Delivery
- 32 Structural Neuroimaging in Late-Life Mood Disorders
- 33 Molecular Imaging in Late-Life Depression
- 34 Functional Neuroimaging in Late-Life Mood Disorders
- 35 Cognitive Biomarkers in Depression
- 36 Neuropathological Markers in Late-Life Depression
- 37 Pharmacogenetics of Late-Life Depression
- 38 Pharmacokinetics and Pharmacodynamics in Late Life
- 39 Psychoneuroimmunology of Depressive Disorders
- 40 The Hpa Axis and Late-Life Depression
- 41 Clinical Prediction Models
- 42 Integration of Biological, Clinical, and Psychosocial Predictors of Treatment Response Variability in Late-Life Depression
- 43 Conclusion
- Index