Longer-acting benzodiazepines should be avoided because risk of accumulation and of toxicity is increased, leading to drowsiness, memory impairment, and impaired balance with falls and fractures. Zolpidem's advantages over benzodiazepines are less disturbance of the sleep profile, fewer rebound effects, and less dependence potential. These drugs appear to be as effective as tricyclic antidepressants and produce less toxicity, especially in overdose. One possible disadvantage of fluoxetine is its long elimination half-life, especially of its active metabolite. P-450 2D6 enzyme activity, with risk of impairing the metabolism of several drugs, including some antipsychotics, antiarrhythmics, and tricyclic antidepressants.
Tricyclic antidepressants are effective.
Overdose produces cardiac and neurologic toxicity, precluding the use of these drugs in patients at risk of suicide. Trazodone is useful in agitated patients, has low anticholinergic potency, and is less cardiotoxic than tricyclics, but it can produce priapism. Bupropion is noncardiotoxic but can increase risk of seizures. Methylphenidate can be useful in treating selected elderly patients with depression who have had a stroke or who have a medical illness. The drug's onset of action is rapid.