Which selective SSRIs should not be used to treat elderly patients?

Sarah N. Mourra, MD
Certain selective serotonin reuptake inhibitors (SSRIs) are avoided in elderly patients. In general, doctors try not to prescribe fluoxetine (Prozac) or paroxetine (Paxil) to treat older adults for several different reasons. Prozac has a very long half-life, which means it stays in the body longer. If the individual is having bad effects from it, those effects take longer to go away after stopping the medication. Also, Prozac can lead to increased anxiety for some people.
Paxil tends to have anticholinergic effects. In dementia, there is a lack of acetylcholine in the brain. Any medication that is anticholinergic contributes to the problem, reducing the level of acetylcholine and impairing cognition. Even individuals who do not have dementia who suffer from depression and are started on a medication like Paxil with strong anticholinergic effects may have cognitive dulling from it. Other anticholinergic effects can include urinary retention, difficulties with passing urine, as well as dry mouth and constipation. People with dementia may already be struggling with many of these issues, and this medication can potentially make these things worse.

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