PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN

PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN

Risks and Benefits of FDA-Approved Drug for Lexapro (escitalopram), the FDA-approved medication for MDD, the benefits include its proven effectiveness in treating depression, including in older adults. Lexapro is a selective serotonin reuptake inhibitor (SSRI) that helps increase the levels of serotonin in the brain, which can improve mood and reduce depressive symptoms (Raue et al., 2019). The risks associated with Lexapro include potential side effects such as nausea, drowsiness, sexual dysfunction, and the risk of serotonin syndrome, especially when combined with other medications that increase serotonin levels (Raue et al., 2019). Additionally, older adults may be more susceptible to certain side effects, such as hyponatremia (low sodium levels) or bleeding complications (Raue et al., 2019). Therefore, careful monitoring and dosage adjustments may be necessary. Risks and Benefits of Off-Label Drug The benefits of buprenorphine include its potential antidepressant effects, modulation of the opioid system, and the ability to address both depressive symptoms and chronic pain, which can be common in older adults (Kumar et al., 2022). However, the risks associated with buprenorphine include potential side effects such as sedation, respiratory depression, constipation, and a risk of misuse or diversion due to its opioid properties (Kumar et al., 2022). It is important to consider the patient's overall health, pain management needs, and the potential risks associated with opioid use before considering buprenorphine as an off-label treatment (Kumar et al., 2022). Clinical Practice Guidelines Clinical practice guidelines exist for the treatment of major depressive disorder, and they can provide valuable recommendations based on evidence-based research. These guidelines typically consider factors such as the severity of depression, comorbidities, patient preferences, and available treatment options (Avasthi & Grover, 2018). The American Psychological Association (APA) provides clinical practice guidelines for the treatment of major depression in older adults (APA, 2021). These guidelines recommend treatment of CBT (either alone or added to usual care) over no treatment (APA, 2021). The guidelines do not specifically mention Lexapro (escitalopram) for older adults, however, guidelines favor the use of SSRIs as first-line pharmacological treatment of depression for older adults. Following are summary points for this discussion: Given the guidelines, Lexapro (escitalopram) would be recommended as the first-line pharmacological treatment for major depressive disorder in older adults due to its FDA approval and established efficacy (Avasthi & Grover, 2018). However, it is essential to consider individual patient characteristics, medical history, and potential contraindications before prescribing Lexapro. Buprenorphine, as an off-label treatment option, may be considered for older adults with comorbid depression and chronic pain, particularly when other treatment options have been ineffective or contraindicated (Avasthi & Grover, 2018). However, careful riskbenefit analysis and monitoring for potential opioid-related adverse effects are necessary (Heddaeus et al., 2018). Cognitive behavioral therapy is recommended as a nonpharmacological intervention for major depressive disorder in older adults. It can be used alone or in combination with pharmacological

treatment, depending on patient preferences and the severity of depression (Heddaeus et al., 2018). References American Psychological Association. (2021). Clinical practice guidelines for the treatment of depression across three age cohorts. https://www.apa.org/depression-guideline/guideline.pdf