Side Effects of Anti-Depressants on Older People in the United Kingdom - Literature review Example

Side effects of anti depressants on older people in the United Kingdom Literature Review A literature review provides a critical summary of researchon a topic, often prepared to put a research problem in context or to summarize existing evidence (Polit & Tatano Beck, 2008). This literature review seeks to explain the side effects of antidepressant affecting older people in the United Kingdom. The review will utilize available journals that explain the side effects of antidepressants. This information is vital in developing drugs that will be effective in the treatment of depression with fewer side effects. The themes discussed in the review entails; drug choice, antidepressant drugs side effects among the elderly, challenges in the treatment of depressive disorders , antidepressant use in the elderly, treatment principles and choices of antidepressants, effects of dosage on the side effects of antidepressants, duration of antidepressants and antidepressants and falls.. The antidepressant side effects can cause problems for older people when continuing to take their medication in nursing homes and other care centres. It therefore calls for the care providers especially the geriatric nurses to monitor older people more closely and ensure they take their medication, whilst monitoring the side effects, (Anderson, 2012). Many older people in the United Kingdom have been found to react badly to antidepressant drugs. The side effects of the drugs administered makes it difficult for the old people to cope and sometimes is considered as additional side effects. Research materials from Google scholar, Jstor and pub med were utilized in the study. Theme I: Choice of drug The choice of drugs to use among the old people usually depends on the various side effects presented by the drugs. Some of the antidepressant drugs such as amitriptyline, imiprimine and dothiepin have been found to be toxic to the old people if overdosed. Serotonin reuptake inhibitors on the other hand have been found to be safe if improperly utilized (Bambauer et al, 2009). The use of these drugs is however linked with the development of suicidal and violent behaviors. Inadequate understanding of the effects of such drugs on the human brain by both the care giver and the patients has made the side effects even worse (Bambauer et al, 2009). Lack of awareness on the mode of action of such drugs have made it difficult for the nurses in the nursing home to care for the old people and identify the symptoms .Some drug companies have admitted not knowing the side effects of some drugs under this category (Bambauer et al, 2009) . Treatment of mild and moderate depression has become difficult since due to the side effects of the drugs used (Bambauer et al, 2009).The next theme that target side effects of antidepressants among the old people is discussed below; Theme II: Antidepressant drug side effects among the elderly According to Beresford (2010) old age is associated with illness likelihood. Most old people above the age of 65 years tend to experience illnesses such as depression and in the event end up consuming over the counter drugs that have been prescribed inappropriately. In the United Kingdom for example, old age population is around eighteen percent and utilize fourty five percent of all the prescribed drugs. Such drugs especially targeting the depressive symptoms may not have been prescribed with attention to the side effects. Failure to identify the side effects of the antidepressant drugs may result to the people utilizing other drugs to cure than symptoms rather than focusing on dosage adjustments. Beresford (2010)’s study indicates that most of the side effects go unnoticed among the old people in nursing homes and other places due to decreased health expectations among them and inability to complain when they are affected. Most of old people associate the symptoms to old age and hence are unable to differentiate with the side effects of antidepressant. Most of the side effect presented by the old people with depression may be mistaken for age related illness and the effects of the old age (Blake, 2013). Old people in nursing homes rely on the geriatric nurses and care providers to identify the side effects and report them to the care providers. The study identifies that assessment, understanding and management of the antidepressants side effects have to be undertaken among the old people living in such institutions in order to reduce the side effects and promote their health. The next theme of discussion is the challenges in the treatment of depressive disorder. Theme III: Challenges in the treatment of depressive disorders Psychotic depression in older people due to the combination of psychosis and depressive mood disorder can become a challenge for patients and management of their condition. It is unfortunate that sometimes psychotic depression remains undertreated and under diagnosed as compared with other psychiatric illnesses. Misdiagnosis has impacted negatively in the treatment and cure of the illnesses since the old people are given wrong drugs that are unable to treat them effectively (Brandon, 2010). The drugs tend to cause even more side effects and in the process the depressive state of the patient declines. The guideline for the treatment of the psychotic depression has been released (Brandon, 2010), even though appropriate studies have not been carried out to help develop appropriate drugs to help treat the condition. Many of the drugs prescribed in nursing homes by the physician are a combination of antipsychotics and antidepressants resulting in even more side effects that are not identified in the process. The study (Breo, 2010) seeks to identify the various challenges that affect the treatment of depressive disorders which present with psychotic features (Breo, 2010). You could discuss more about the study here, Even though the combination of the drugs are effective in the treatment of the condition, the drug manufactures should ensure the mode of action of the combined drugs do not result in more side effects in the patient. The study (Busfield et al, 2012) indicates that less information regarding the drug’s mode of action has impaired the coping mechanism of the old people especially when the side effects occur. The 4th theme is on antidepressant use among the elderly. Theme IV: Antidepressant use in the elderly Depression presents a significant burden to the patient, the family members and the community where the old person comes from (Caplan, 2010). Evaluation of the precipitating and predisposing factors can be important in early treatment of the condition. The study (Caplan, 2010) indicates that nearly thirty percent of the old people in the community have depressive symptom with few in nursing and geriatric homes (Caplan, 2010). Many patients in geriatric homes have been prescribed antidepressant medication. The medication can cause a lot of side effects to the patient. What makes it even more difficult is the inability of the patient to report some of changes in their bodies pertaining to the drugs used, because the people are unable to differentiate it with those associated with old age. It is also because they are depressed, unable to voice their concerns and confusion. The side effects of such drugs have made it difficult for the old people to adapt since most of these drugs are long term (Caplan, 2010). Some older people may present with reduced interest, low mood, poor sleep, less appetite and energy after using the drugs (Cash, 2011). Most of the old people who present with such symptoms require closer monitoring and increased care (Cash, 2011). Some of the side effects include suicidal ideation increasing the number of the old people who commit suicide in the United Kingdom which are depression related (Cash, 2011). The stigma associated with mental illness in the United Kingdom has made it difficult to deal with the check grammar here condition health providers at the nursing homes should make the use of the rules that are associated with drug administration to prevent more and more side effects related to overdose of the drugs. The health providers should be informed about the current drugs in the market and their mode of action. The care givers who take care of the old should be able to identify and monitor the patient after drug administration to help recognize the symptoms related to the side effects of the drugs. This is part of the qualified nurse’s role (Cash, 2011) .Geriatric nurses should engage with patients and other cares and families and ask them to report changes following drug administration. According to Duncan (2012), close examination will help prevent suicide among the old people which has been reported to be increasing. Where ever possible older people need to be informed about the drug name, the mode of action and the side effects of such drugs before they are even administered. This is all part of consent to treatment and also helps with compliance of medication (Duncan, 2012). Predisposing factors related to depression such as; social isolation, insomnia, chronic stress, recent bereavement and move to nursing home should be evaluated to help identify whether the symptoms are drug related or depressive related (Duncan, 2012). The study conducted by Duncan (2012) indicates that most recent research has been directed on depression among the young people underrating the conditions in the old people yet they are the ones mostly affected. Old people have been seen to respond to high dosage of antidepressant medication. High dosage of such drugs comes with more side effects. The pharmaceutical companies are now faced with challenges of ensuring the drug manufactured does not pose excessive side effects to the old people (Duncan, 2012). Link sentence here Theme V : Treatment principle Gottfries (2011)’s study indicates that previous treatment response may be a concern when choosing an antidepressant for the elderly. Other factors to be considered includes; other medical conditions, other medications and the risk of drug overdose. Understanding all these situations may enable the health providers to care for the old person effectively and reduce the drug side effects. Old age is associated with so many illnesses and the patient may be on other drugs that are not related to antidepressants (Gottfries, 2011). Check grammar Drug action affects each other either positively or negatively. There are drugs which impair the action of others while some promote and improve the action of antidepressants. Drugs that impair the action of antidepressant should not be administered with antidepressants (Gottfries, 2011) . Other antidepressant drugs have been known to produce better result if administered with other drugs. Mood stabilizers for example have to be administered with drugs associated with treatment of bipolar depression in old people. Antidepressant therapies that are not well administered may worsen other medical conditions such as Parkinson disease, cardiovascular problems, dementia and diabetes (Gottfries, 2011). The health providers in a nursing home have a role to ensure the patient takes medication as prescribed. The drug-drug interactions have to be minimized since it can affect cardiac conduction abnormalities and may result in postural hypotension. Tricyclic antidepressants are an example of a drug that is lethal when overdosed and should therefore be monitored well during administration (Holly, 2012). Why is it lethal, what are the implications. The next theme explains about the choice of the antidepressants. Theme VI: Choice of antidepressants Katona (2010)’s study indicates that selection of an effective antidepressant should be determined by drug-drug interaction risks and the side effect profile. Older people with cardiovascular disease have been known to respond well to drugs such as buproprion, mirtazapine and venlafaxine which are all antidepressants. Side effects of selective serotonin reuptake inhibitors (SSRI) that are common with the elderly people include; insomnia, somnolence, diarrhea, sexual dysfunction, dry mouth and sweating (Katona, 2010). The health provider should be able to identify such symptoms after drugs are administered and use proper interventions to deal with it. Using of drugs such as Tricyclic anti depressants have been known to be lethal to older people especially if overdosed (Katona, 2010). Such drugs have been associated with postural hypotension and are to be avoided in old people especially those who are not closely monitored. Postural blood pressure and ECGs have to be undertaken following drug administration with an intention of identifying side effects of antidepressants and intervene accordingly. Given the drug-drug interactions and side effect profile associated with monoamine oxidase inhibitor, the drug is neither a second nor a first antidepressive agent in the treatment of depression (Katona, 2010). The next theme of discussion explains how dosage affects side effects of antidepressants. Theme VII: How dosage affect side effects of antidepressants The antidepressant dosage for an older person should be half of that prescribed for a young person (Lieb, 2012). The aim is to ensure the side effects are minimized as possible and maintain therapeutic levels. The liver and kidneys of older people are less able to excrete products so dosages of medication have to be prescribed accordingly. The increased antidepressant side effects among the older people are related to concurrent medical condition, drug-drug interaction and reduced metabolism that is associated with the aging process (Lieb, 2012). The current practice on treatment of depression stipulates that, treatment should begin with a lower dose and then increased regularly until a therapeutic level is achieved with minimal side effects (Lieb, 2012). The health providers at the nursing homes should ensure the side effects of the drug on the patient are monitored closely. The current practice (Lieb, 2012), targeting the use of antidepressant stipulates that, the drug used is replaced if the action of the drug does not affect or improve the patient’s condition. Changing from one drug to the other increases the side effect the patient has to be adviced and helped to cope with it. The two anti depressants that are being changed should not interact with each other. Some of the drug side effects have been associated with falls, weight gain, diabetes and dyslipidemia (Lieb, 2012). Patient in the nursing homes should thus be assisted in movement and doing other activities. The next theme of discussion entails, the duration of antidepressant administrations. Theme VIII: Duration of antidepressant administrations According to the study conducted by Schweitzer et al (2010), a lot of misinformation on antidepressant use and lack of explanation on its mode of action has resulted in increased side effects amongst older people in nursing homes in the United Kingdom. Antidepressants are used in the treatment of anxiety disorders, severe and moderate depression. Severe episode of depression calls for the physician to prescribe both psychological treatment drugs and antidepressants for treatment of depression (Schweitzer et al, 2010). Old people in nursing homes who present with psychosis and bipolar depression need to be assessed which may result in them, being prescribed medication. Antidepressants with fewer side effects such as the reversible inhibitors of monoamine oxidase should be utilized in the treatment. Some drugs such as Tricyclic antidepressants have to be avoided or monitored well since they have harmful and severe side effects especially in overdose cases (Schweitzer et al, 2010) . The response to treatment and the severity of the condition determine the extent of drug use. Stoppage of use should be directed by the physician and not abruptly since the depressive symptoms may end up worsening. Older people respond differently to medication and therefore close observation is of essence. It usually takes patience and time to find a drug that works well with a certain patient. The health providers should monitor the patient and retrieve information pertaining to the efficacy and reaction to the drugs. Older people usually find it a challenge when they are first introduced to antidepressant drugs due to their bodies’ reaction to the drug. According the study Katona (2011), most of such drugs begin to function more effectively after 2-4 weeks (Katona, 2011). Side effects are expected to continue for only a few weeks before they start to decline depending on the type of drug used. However it is during this time that compliance with medication may become an issue. Many drugs have side effects however the nature and severity of the side effect vary from one drug to the other. Monoamine oxidase inhibitors which are an antidepressant results in symptoms such as stiff neck, severe headache and increased heart beat rate (Khawam et al, 2012). Such symptoms may become worse and if they persist the nurse in charge should ensure appropriate measures are taken. Thus there are implications for the role of the nurse and care providers. The physicians should be informed to find out if there is need to change the drug being utilized. Continuous use of serotonin reuptake inhibitors has been found to cause serotonin syndrome (Khawam et al, 2012). This syndrome occurs as a result of increased accumulation of serotonin chemical in the brain. The study (Khawam et al, 2012) found out that confusion, muscle twitching, diarrhea and shivering are part of the symptoms associated with serotonin syndrome. The patient has to report the changes to the care giver in charge to get help. Decline in sodium levels has been reported amongst older patients in nursing homes especially the ones on selective serotonin reuptake inhibitors (Siegfried & Connolly, 2010). If not controlled, accumulation of sodium levels results to build up of fluids in cells of the body causing oedema. Severe cases of the symptoms cause agitation and disorientation. Health practitioners have to be observant to prevent severe side effects. . Antidepressants have to be changed in cases where the patient is unable to tolerate the drugs side effects (Siegfried & Connolly, 2010). The finding of Siegfried & Connolly (2010)’s study also indicates suicidal ideation as one of the side effects of the antidepressant drugs affecting the older people in nursing homes in the United Kingdom. According to a study conducted by Harmon (2009), antidepressants are the drugs commonly utilized in treatment of patient with depressive condition. Antidepressants can also be used when treating post- traumatic stress disorders, obsessive compulsive disorder, substance abuse, eating disorders and substance abuse. All these conditions can affect older people. Antidepressant drugs were the most prescribed drugs for older people in the United Kingdom in the year 2010 (Harmon, 2009). Though many prescribed drugs present various side effects to people who utilize them, antidepressants present more side effects (Harmon, 2009). When not properly used they appear to cause more harm than the depressive condition symptoms the person originally needing treatment. The study (Harmon (2009) indicates that the health providers such as nurses and other physicians should be liable and responsible for the drugs they prescribe. They have the necessary information pertaining to the drug. Keeping the patient informed about the side effects of the drugs that they are using will ensure they are able to cope with the emerging side effects and report in cases where they cannot cope (Pelosi, 2011). The study (Kikuchi et al, 2010), recommends that health providers should keep the patient informed about the side effects and the mode of action of the drugs. Return of depressive symptoms after the patient is treated with the drug is associated with the pushing back on antidepressive effect by the brain. The brain is thought to resist the effect of drugs by pushing the drug out of the brain. The doctors tend to increase the dosage without necessarily considering the effect of the brain on the drug and in the process result to increased side effects (Kikuchi et al, 2010). The health provider should direct the patient on the need to continue taking the drugs even when the symptoms of the condition disappear. The action of the brain on the drug will make it easier for the symptoms to relapse after the use of drug is stopped. The drugs have been found to cause damage to the neurons (Kikuchi et al, 2010). Damage to the neurons may result to abnormal firing and hence the development of tardive dyskinesia and parkinisonian symptoms. The symptoms are associated with repetitive and involuntary movement among the old people in the nursing homes (Kikuchi et al, 2010). Close monitoring and assistance is needed to help the old people move around. According to the study conducted by Hindmarch et al (2012), antidepressants have been associated with protection against cancer of the brain but raise breast cancer risk. Current study (Hindmarch et al (2012) has been directed at these issue. Antidepressants impair the cognition due to its effect on the neurons. The extended use of the drug on rodents declined its ability to learn some tasks. The ref study recommends that old people should be assisted in doing activities that are related to cognition as prolonged use of the drug has been associated dementia and cognitive impairment. (Rizo, 2010)’s has indicated that prolonged use of antidepressants among older people increase the risk of death. Antidepressants have been found to affect nearly all the body activities that are associated with serotonin (Rizo, 2010) .The drugs have been found to affect major body functions and in the process increasing the risk of death. The drug has also been associated with falls among the old people (Rizo, 2010). In the event of a fall, a person may end up with fractures making it difficult for movements to take place. Hyponatremia a symptom of prolonged use of antidepressants and has been found to cause death and respiratory arrest (Rizo, 2010). Though the patient and the physician hope for the best result after administration of drugs, understanding the side effects of the drugs will improve the patient’s compliance and hence better results will be achieved (Rizo, 2010). (Rizo, 2010)’s study concludes that antidepressants cause more harm to the body than treating the symptoms. The drug has been known to be so beneficial in facilitating stroke recovery and cure of brain tumors (Rizo, 2010). (Rizo, 2010) ’s study recommends that physicians have to prevent more harm to the patient by being keen to prevent overdose through monitoring the drug intake and advising the patients accordingly. Upadhyaya & Devane (2013)’s study has indicated that antidepressants are more toxic and less effective in the treatment of depression among the older people in nursing homes in the United Kingdom. From legal, ethical and health perspectives, medical organizers and individual practitioners should reconsider and revise issues concerning utilization of antidepressant drugs in the treatment of the patients especially the old people above sixty five years of age (Upadhyaya & Devane, 2013). The side effects and the symptoms of the drugs should be weighed before administration is done. Weighing the side effect will enable the physician to prescribe a drug with fewer side effects to the elderly patient. The health practitioners have to collaborate with the patient to identify the need to change the drug or find out if the older people are able to cope with the side effects (Upadhyaya & Devane, 2013). According to Pacher & Kecskemet (2010), antidepressants were developed sixty four years ago and have been continuously prescribed since then. The noradrenaline and specific serotonigernic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, the Tricyclic and serotonin and noradrenaline reuptake inhibitor are some of the classes of antidepressants manufactured to be utilized in the treatment of depression. The drugs are known to enhance the activity of certain chemicals in the human brain. Example of the chemicals targeted is the noradrenaline and serotonin. According to Pacher & Kecskemet (2010) , the drugs are prescribed for older people who present with; chronic pain, posttraumatic stress disorder, eating disorders, panic attacks and depressive illnesses. New drugs such as Tricyclic antidepressants have fewer side effects though harmful when overdosed (Pacher & Kecskemet, 2010). The health practitioners in care of the old people with depressive conditions should be able to give assistance to help the patients in performance of activies of the daily living. According to Pacher & Kecskemet (2010), antidepressants are not addictive and the patient does not crave for them as is the case with tranquilizers. Most of the patients who stop using the antidepressants have been found to present with withdrawal syndromes. Suicidal ideation presents majorly in young people with depression unlike the old people in the nursing homes however the drugs should be not stopped without the physician’s recommendation. Alcohol intake has been found out to worsen the depressive condition (Parker, 2011). The health providers should therefore advise the patients against use of alcohol especially the ones being discharged home from the nursing homes. The patients have to avoid activities such as driving especially when under antidepressant medication. The instruction s pertaining to the drugs should be well explained and elaborated. The information on patient progress and the drugs prescribed should be outlined and documented for continuity of care. Old patients on antidepressants have to be monitored closely especially after the drugs are administered (Rozzini, 2010). The patient should be encouraged and provided with psychological support (Rozzini, 2010). The treatment of depression usually takes a longer time and the patients have to be encouraged to continue taking the drugs most of which are oral. The next theme of discussion entails relationship between antidepressants and falls. Theme IX: Antidepressant and falls Livingston et al, (2012) conducted a study targeting the use of antidepressants and the risk of falls amongst older people staying in a nursing home in the United Kingdom. The study found out that the use of Tricyclic antidepressants among the people living in nursing homes raised the risk of falls. Current drugs such as Serotonin reuptake inhibitors are however free from most of the side effects. The study found out that more first time users of antidepressants were more likely to experience falls than the non users. The rates of falls persisted for the first months due to increase in dosage prescribed by the physicians. Such patients needed closer monitoring to prevent them from ending up with fractures. The health providers in various nursing homes in the United Kingdom are required to report any incident of falls that occur. The antidepressant drugs that the patient is using has to be assessed in cases of falls and new drugs prescribed. Tricyclic antidepressants have been found to cause more injuries to patients that are related to falls (Livingston et al, 2012). Livingston et al (2012) ‘s study recommends the use of selective serotonin reuptake inhibitors which has few side effects. Summary Antidepressant drugs present a lot of challenges to older patients and health providers in nursing homes in the United Kingdom. The health providers should involve the patient in the care by providing relevant information targeting the mode of actions and the side effects of the drugs. The patients should also be encouraged to report any abnormal changes after taking the drugs. The information will be vital to the physician since it will provide direction on whether to change the drug or maintain it (Margolese et al, 2012). Health providers especially the geriatric nurses and other care assistant should monitor the patient closely and provide necessary assistance to patient in need. Gap of knowledge “To identify anti depressant medications that are commonly used but fewer side effects in elderly patients”. References Ancher, S. (2011). Interaction between neuroleptics and tricyclic antidepressants may exaggerate some side effects. Reactions, 2-2. Anderson, D. (2012). 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