Is sertraline (selective serotonin reuptake inhibitor) suitable for treating agitation in a geriatric patient with subsequent referral to psychiatry?

From the Guidelines

Sertraline can be used to treat agitation in geriatric patients, but it should be used cautiously and is not typically the first-line treatment for acute agitation. For geriatric patients with agitation, it's best to start with non-pharmacological approaches such as environmental modifications, addressing unmet needs, and behavioral interventions 1. If medication is necessary, sertraline (starting at a low dose of 25mg daily, with slow titration) may be beneficial if the agitation is related to depression or anxiety, but it takes several weeks to show full effect 1. For acute agitation, other medications like low-dose atypical antipsychotics might be more appropriate for short-term use 1. Some key points to consider when using sertraline in geriatric patients include:

• Starting with a low dose and titrating slowly to minimize the risk of adverse effects 1
• Monitoring for potential drug interactions and side effects, particularly in older adults who may be more sensitive to medications and often take multiple drugs 1
• Considering alternative treatments, such as low-dose atypical antipsychotics, for acute agitation 1
• Promptly referring the patient to psychiatry for comprehensive evaluation and management, as agitation often has complex underlying causes including medical conditions, medication side effects, or psychiatric disorders that require specialized assessment 1. Regardless of the initial medication choice, it is essential to prioritize the patient's safety and well-being, and to consider the potential risks and benefits of each treatment option.

From the FDA Drug Label

The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric Geriatric Use U. S. geriatric clinical studies of sertraline in major depressive disorder included 663 sertraline-treated subjects ≥65 years of age, of those, 180 were ≥75 years of age No overall differences in the pattern of adverse reactions were observed in the geriatric clinical trial subjects relative to those reported in younger subjects

Sertraline use in geriatric patients with agitation:

• Sertraline can be used in geriatric patients, but caution is advised due to the potential for adverse reactions, such as hyponatremia.
• Monitoring is recommended for the emergence of agitation, irritability, and other symptoms.
• It is essential to refer to psych for further evaluation and management of agitation in geriatric patients.
• The decision to use sertraline should be made on a case-by-case basis, considering the patient's overall health and medical history 2 2.

From the Research

Sertraline for Agitation in Geriatric Patients

• Sertraline is a selective serotonin reuptake inhibitor (SSRI) that has been studied for its effectiveness in treating major depressive disorder in elderly patients 3.
• While sertraline has been shown to be effective in treating depression in elderly patients, its use in treating agitation in geriatric patients is less clear.
• One study found that SSRIs, including sertraline, may be associated with a reduction in symptoms of agitation in patients with dementia 4.

Pharmacologic Management of Agitation

• The pharmacologic management of agitation in patients with dementia involves a range of medications, including antidepressants, antipsychotics, and anti-epileptics 5.
• The choice of medication depends on the patient's comorbidities, specific symptoms, and tolerance of medications.
• SSRIs, such as sertraline, may be considered for the treatment of agitation in geriatric patients, particularly those with dementia 4.

Referral to Psychiatric Care

• Referral to psychiatric care may be necessary for geriatric patients with agitation, particularly if the agitation is severe or persistent.
• Psychiatric care can provide a comprehensive evaluation and treatment plan, including medication management and behavioral therapies.
• Studies have shown that a combination of pharmacologic and non-pharmacologic interventions can be effective in managing agitation in geriatric patients 5, 4.

Considerations for Sertraline Use

• Sertraline is generally well-tolerated in elderly patients, but may have side effects such as dry mouth, headache, and diarrhea 3.
• The use of sertraline in geriatric patients requires careful consideration of the patient's medical history, comorbidities, and current medications.
• Studies have shown that sertraline may be a suitable alternative to other antidepressants, such as trazodone, in geriatric patients 6.