A renaissance for fluoxetine in the management of depression in the elderly?

OBJECTIVE: To review the literature pertaining to the use of the selective serotonin reuptake inhibitor (SSRI) fluoxetine in the management of depression in elders. DATA SOURCES: A MEDLINE search was conducted to identify pertinent studies, case reports, letters, and reviews in the English language. All articles published from 1986 to 2002 were reviewed. Additional references were obtained from bibliographies of those articles. STUDY SELECTION: All studies evaluating any aspect of the use of fluoxetine in managing geriatric depression. DATA SYNTHESIS: Pharmacokinetic studies have demonstrated that the potential for accumulation of fluoxetine and its active metabolite norfluoxetine with chronic dosing in elders is less than or equal to that in young individuals. Renal impairment, a frequent comorbidity of older age, has no significant effect on the pharmacokinetics of fluoxetine/norfluoxetine. In elders, the efficacy of fluoxetine is statistically indistinguishable from that of paroxetine, sertraline, fluvoxamine, and tricyclic antidepressants in controlled trials, as are the adverse event profiles of fluoxetine and other tested SSRIs. The drug interaction potential of fluoxetine is similar to that of fluvoxamine and paroxetine and greater than those of citalopram, escitalopram, and sertraline. CONCLUSION: Available data support a reevaluation of the role of fluoxetine in the management of geriatric depression, especially in light of the recent marketing of a generic fluoxetine product that is priced much lower than competitor branded SSRIs. Further studies of fluoxetine use in geriatric depression using adequate numbers of patients are recommended.