Caution in the Use of Drugs in the Elderly

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Abstract
To the Editor: In their article on psychotropic drug use in the elderly, Thompson et al. (Jan. 27 issue)* emphasize the reduced clearance of antidepressant drugs in the elderly and recommend low initial doses. However, they do not address the problem of under-dosage.Antidepressant pharmacokinetics show great interindividual variation, and it is not uncommon to see elderly patients who have inadequate serum levels of tricyclic antidepressants while they are taking conventional adult dosages, let alone the reduced dosages recommended for the elderly. For example, a 68-year-old woman treated recently for retarded depression had no response to 250 mg of desipramine . . .

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