Effect of age and gender on citalopram and desmethylcitalopram steady-state plasma concentrations in adults and elderly depressed patients.

The effect of aging on steady-state plasma concentrations of citalopram (CIT) and desmethylcitalopram (DCIT) was investigated in 128 depressive patients treated with 10-80 mg/day CIT. They were separated into three groups, with age up to 64 years (mean age+/-S.D.: 47+/-12 years; n=48), between 65 and 79 years (72+/-1 years; n=57), and from 80 years or older (84+/-1 years; n=23). Body mass index (BMI), renal and hepatic functions were similar in the three groups. A large interindividual variability of plasma levels of CIT (16-fold) and DCIT (12-fold) was measured for a given dose. The mean plasma levels of CIT corrected for a 20 mg daily dose were 55% higher in the very elderly (>=80 years) patients (65+/-30 ng/ml; p<0.001) and 38% higher in the elderly (65-79 years) patients (58+/-24 ng/ml; p<0.001) when compared to the adult patients (42+/-17 ng/ml). DCIT mean plasma level was 38% higher (p<0.05) in the group of very elderly patients (22+/-10 ng/ml) when compared to the adult patients (16+/-9 ng/ml). As a consequence, the mean plasma concentration of CIT+DCIT was 48% higher in the very elderly patients (86+/-36 ng/ml; p<0.001) and 33% higher in the elderly patients (77+/-28 ng/ml; p<0.001) when compared to the adult patients (58+/-21 ng/ml). Age correlated significantly with CIT (r=0.43, p<0.001), DCIT (r=0.28, p<0.01), and CIT+DCIT plasma levels (r=0.44, p<0.001), and thus accounts for 18% of the variability of CIT plasma levels, with no influence of gender. The recommended dose reduction of CIT in elderly patients seems therefore justified.

Reducing stigma and discrimination against older people with mental disorders: a technical consensus statement.

This technical consensus statement is jointly produced by the Old Age Psychiatry section of the World Psychiatric Association and the World Health Organization, with the collaboration of several NGOs and the participation of experts from different Regions. It is intended to be a tool for (i) promoting debate at all levels on the stigmatisation of older people with mental disorders; (ii) outlining the nature, causes and consequences of this stigmatisation; and (iii) promoting and suggesting policies, programmes and actions to combat this stigmatisation.

Stigma and discrimination against older people with mental disorders in Europe.

BACKGROUND AND OBJECTIVES: The European Office of the World Health Organization (WHO/EURO) has established a Task Force On Destigmatization. Upon the release of the Technical Statement on Old Age Psychiatry 'Reducing stigma and discrimination against older people with mental disorders', the Task Force run a small survey in two European subregions to investigate the extent of stigma and discrimination with reference to the elderly person affected from a psychiatric disorder in the countries of those subregions. METHODS: WHO/EURO mental health counterparts completed a short questionnaire inquiring on the inclusion of epidemiological studies on the elderly in their country's research program; the time devoted to the teaching to old age psychiatry during psychiatric residence; the degree of coverage of services for the elderly person and their caregivers; and the extent of stigma present in society with regard to three psychiatric disorders. RESULTS: Stigma and discrimination seem to be present both in the health sector and among the public at large. CONCLUSION: The development of effective health and social facilities to support older persons with mental disorders should be a high priority of any strategy to reduce stigma and discrimination. These facilities should coordinate their efforts with those of other sectors of society to reach the highest possible impact.