Moreover, because depression generally is recognized as a serotonin-deficit disorder and SSRIs increase the serotonin concentration in the presynaptic membrane, they are a logical choice for the treatment of depression. SSRIs are preferred for elderly patients because they do not cause orthostatic hypotension, cardiotoxicity, anticholinergic effects, or other limiting adverse effects common to tricyclic antidepressants, monoamine oxidase inhibitors and even some of the other newer antidepressants. Nevertheless, they must be used with caution in some patient populations. Maprotiline hydrochloride is contraindicated in patients with a history of seizures. Amoxapine is associated with an increased risk of tardive dyskinesia and should be used only for patients in whom therapy with safer antidepressants has failed.
Trazodone hydrochloride can cause significant drowsiness, orthostasis, and priapism.
Therefore, it must be used cautiously in elderly patients and male patients. Nefazodone hydrochloride may interact with benzodiazepines, causing increased sedation and alpha 1 - adrenergic effects. However, this drug may serve as an alternative for patients in who other antidepressants cause significant sexual dysfunction. All of these properties make it a particularly useful agent in depressed elderly patients who exhibit lethargy and psychomotor retardation. Bupropion should be considered for patients who cannot tolerate the adverse effects of SSRIs, but only after therapeutic trials of at least two different SSRIs.