Duloxetine in the management of elderly patients with major depressive disorder: an analysis of published data

Background: Major depressive disorder (MDD) is a common condition in the elderly that is frequently associated with disability and cognitive impairment. Duloxetine is an antidepressant medication that inhibits both 5-HT and NE reuptake. Objective: The objective of this review is to summarize the available know-how on the use of duloxetine in elderly population. Methods: An extensive literature search was performed in Medline and Embase. Peer-reviewed articles only were included in this review. Results: A total of four articles meeting search criteria were identified in the Medline and Embase databases. In the short-term controlled studies, treatment with duloxetine was associated with significantly greater improvement in cognitive function, depression and health state compared with placebo, as well as in rate of patients achieving response or remission. Overall pain and back pain also improved in patients receiving duloxetine. The long-term open-label data showed that the significant improvements of HAM-D-17 score and of both clinician- (CGI-S) and patient- (PGI-I) rated health state were rapid and sustained up to week 52. Observed case response and remission rates at end point were 89.4% and 72.3% respectively. Duloxetine was effective in patients who did not respond or tolerate previous treatment with escitalopram. Nausea and dry mouth were the most common events. The safety results in the long-term study, in which duloxetine was given at the upper dose limit, showed that most events occurred early in the study and that rates of events in patients aged >= 65 years were not greater than those in the younger cohort. Conclusions: Duloxetine given in elderly patients with MDD provides rapid and sustained antidepressant efficacy and seems to be as safe as in younger patients.