Depression

Selective serotonin re-uptake inhibitors (SSRIs) are inappropriate to use in patients aged 65 years and older with current or recent significant hyponatraemia i.e. serum Na+ < 130 mmol/l (risk of exacerbating or precipitating hyponatraemia).

   Tricyclic antidepressants (TCAs) are inappropriate to use in patients aged 65 years and older:

• if they have dementia, narrow angle glaucoma, cardiac conduction abnormalities, prostatism, or prior history of urinary retention (risk of worsening these conditions)
• for initiation as first-line antidepressant treatment (higher risk of adverse drug reactions with TCAs than with SSRIs or SNRIs).
• if concomitant use of two or more drugs with antimuscarinic/anticholinergic properties (e.g. bladder antispasmodics, intestinal antispasmodics, tricyclic antidepressants, first generation antihistamines) (risk of increased antimuscarinic/anticholinergic toxicity)