Geriatric Psychiatry — MCQs

Q: Which of the following antidepressants can be safely used in elderly depression?

Mianserin. In geriatric psychiatry, the choice of antidepressant is dictated by the side-effect profile, specifically the risk of anticholinergic effects, sedation, and cardiovascular complications. **Why Mianserin is correct:** Mianserin is a tetracyclic antidepressant (TeCA) that is frequently preferred in the elderly because it lacks significant **anticholinergic side effects** (which cause confusion, urinary retention, and glaucoma) and has minimal **cardiotoxicity**. It is particularly useful in elderly patients with insomnia or agitation due to its sedative properties, but it does not typically cause the severe orthostatic hypotension seen with older TCAs. **Analysis of Incorrect Options:** * **Fluoxetine (Option C):** While SSRIs are first-line for the elderly, Fluoxetine has a very **long half-life** (and active metabolites) which can lead to accumulation and prolonged side effects (like hyponatremia/SIADH or agitation) in patients with age-related renal or hepatic decline. Sertraline is generally preferred over Fluoxetine in this age group. * **Trazodone (Option A):** Though used for sleep, it is notorious for causing significant **orthostatic hypotension** in the elderly, increasing the risk of falls and hip fractures. * **Phenelzine (Option D):** As a non-selective MAOI, it requires strict dietary restrictions and carries a high risk of **hypertensive crisis** and drug-drug interactions, making it unsafe for the polypharmacy often seen in geriatric patients. **NEET-PG High-Yield Pearls:** * **Drug of Choice:** SSRIs (specifically **Sertraline** or **Escitalopram**) are generally the first-line treatment for elderly depression. * **Mianserin Risk:** Always monitor for **agranulocytosis** (rare but serious). * **Avoid:** Tertiary amines (Amitriptyline, Imipramine) due to high anticholinergic activity. * **Key Concern:** Always check for **hyponatremia** (SIADH) when starting an SSRI in an elderly patient.

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Normal Aging Process

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Dementia: Alzheimer's Type

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Other Neurocognitive Disorders

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Delirium in the Elderly

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Late-Life Depression

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Anxiety Disorders in the Elderly

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Psychosis in the Elderly

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Sleep Disorders in the Elderly

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Pharmacotherapy Considerations in the Elderly

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Elder Abuse and Neglect

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End-of-Life Issues

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Long-term Care Issues

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