To the Editor.—
A recent article by Beers et al1 and editorial by Dr Riesenberg2 comment on psychotropic drug use and polypharmacy in institutionalized geriatric patients. The established view in geriatric psychiatry that is reiterated by these articles is that the choice of psychoactive medication should be primarily based on two considerations: efficacy in treating psychopathology and potential toxicity. Another consideration is important: some of these agents, especially tricyclic antidepressants, effectively treat gastrointestinal disorders.3Almost half of patients admitted to the hospital for acute peptic ulcer disease are over 65 years of age4 and up to 90% of elderly individuals have hiatus hernia.5 The antihistaminic action of these drugs, eg, of amitriptyline, doxepin, and trimipramine, is presumably a factor in the healing of peptic ulcer disease and the relief of gastric acid hypersecretion. The anticholinergic activity of these drugs may contribute to this healing process
Kushnir SL. Drugs in the Institutionalized Elderly. JAMA. 1989;261(14):2067–2068. doi:10.1001/jama.1989.03420140068027
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