Table 3 Therapeutic strategies in geriatric depression
Clinical features | First intention | Second intention | Contra-indications |
|---|---|---|---|
Mild to moderate intensity | - SSRI - α2 antagonist | - SNRI - Agomelatine | - Irreversible MAOI - Bupropion - Association with an ATD from the same pharmacological class - Anticonvulsant - ECT |
Moderate to severe intensity | - SSRI - SNRI - α2 antagonist | - Imipraminic | - Bupropion - Association with an ATD from the same pharmacological class - Anticonvulsant - First generation antipsychotic |
Severe cognitive impairments | - SSRI - SNRI | - α2-antagonist - Agomelatine | |
Severe psychomotor agitation | - SSRI - α2 antagonist | - SNRI - Potentiation with AAP | - Bupropion - Tianeptine - Irreversible MAOI - Association with an ATD from the same pharmacological class |
Severe psychomotor retardation | - SSRI - SNRI | - α2-antagonist - Imipraminic - ECT in association | - Tianeptine - Bupropion - Association with an ATD from the same pharmacological class - First generation antipsychotic |
Severe sleep disorders | - SSRI - α2 antagonist | - SNRI - Agomelatine | - Tianeptine - Irreversible MAOI - Bupropion - Association with an ATD from the same pharmacological class |
Severe anhedonia | - SSRI - SNRI | - α2-antagonist - Imipraminic - Agomelatine | - Association with an ATD from the same pharmacological class - Anticonvulsant - First generation antipsychotic |
Psychotic symptoms | - SNRI - Potentiation with AAP | - SSRI - α2-antagonist - Imipraminic - ECT in association | - Tianeptine - Irreversible MAOI - Bupropion - Association with an ATD from the same pharmacological class |
High suicidal risk | - SSRI - SNRI | - α2-antagonist - Imipraminic - ECT in association Potentiation with AAP | - Tianeptine - Bupropion - Association with an ATD from the same pharmacological class - First generation antipsychotic |