Abstract
Prescribing psychotropic medications for the elderly often presents some challenges. Elderly patients can vary widely in their ability to tolerate and respond to individual medications. They may have multiple physical problems making it harder to find a safe and appropriate option, and there may be a high risk of interactions with other medications. In addition, issues of capacity and consent can add to the complexity of this practice. Therefore, Psychotropic drugs and the elderly: fast facts by Joel Sadavoy is welcome for its focus on this topic and its stated intention ‘to provide rapid access to very thorough information’ (p. 5).
A short introduction includes a discussion on pharamacokinetics and pharmacodynamics with relevance to the elderly population. Five subsequent chapters cover the main groups of medications: antidepressants, antipsychotics, anti-anxiety drugs, mood stabilizers and cognitive enhancers. As well as detailed coverage of individual medications, the chapters also contain overviews of the relevant medication classes, and summaries of the psychiatric conditions for which the medications might be used.
Sadavoy's book contains a lot of useful information and he has clearly made an effort to give priority to that which is clinically important. A strength of the book is the provision of practical and specific recommendations on topics such as choosing a medication and dosing. The coverage of side-effects and interactions is also very good. The focus on the elderly is consistently integrated throughout the text and the book is not merely a rehash of other general psychopharmacological textbooks with a few superficial changes to fit this age group!
Throughout the book Sadavoy refers frequently to the evidence supporting various treatments, and notes where this evidence is derived from general adult data and where it is from trials specific to the elderly. The arrangement of references with sections for each individual medication is helpful, but I would have also preferred key studies to be directly referenced in the text.
Despite its title I did not initially find this a particularly easy book to consult. The bullet point format is often helpful but the almost exclusive use of this technique can seem contrived and does not always add clarity. When combined with the long chapters, relatively small page size, some variations between chapters in the order in which information is presented, and tables that are sometimes spread over several pages, it can be difficult to quickly locate relevant facts. In addition it is sometimes necessary to look in several places in the book to gather information about a particular medication as a result of attempts, albeit understandable, to avoid repetition in the text.
Because elderly psychiatric patients often have comorbid physical illnesses a frequent question when prescribing for this group is which of a number of possible psychotropic medications might be the least likely to cause problems in a patient with a particular medical condition. Sadavoy's book contains much of the required information to make such decisions but a book such as Stephen Bazire's Psychotropic drug directory[1], while not specifically focused on the elderly, is more helpful in this situation because it provides quick comparisons of psychotropic medications for several important medical conditions.
That said, Psychotropic drugs and the elderly: fast facts remains a clinically useful and detailed reference when prescribing for elderly patients and it is worthy of recommendation to those working in the psychogeriatric field.
Colin Peebles
Christchurch, New Zealand
© 2007 Colin Peebles