"Bruce Pollock has been one of the true leaders of the field for some time now," said outgoing AAGP President Gary Kennedy, M.D., "helping discover new treatments in caring for older adults, but more importantly in helping ensure that existing treatments are as safe and effective as they can be."

Pollock, a professor of psychiatry, pharmacology, and nursing and chief of the academic division of geriatrics and neuropsychiatry at the University of Pittsburgh, has focused his research over the last 20 years on the fundamentally different effects medications may have when prescribed to the elderly. In particular, he has studied differences in the absorption, distribution, and metabolism of, as well as varying sensitivity to, medications commonly prescribed to the elderly.

"This award recognizes our critical social need for more knowledge about medications in older adults, a neglected, complicated, medically burdened population," Pollock said. "Older patients are proportionally the largest consumers of prescription medications, but we have the least amount of basic drug information for this population. It is absolutely critical for us to study the efficacy, metabolism, drug interactions, and side effects of psychiatric and other drugs in elders."

Pollock has held a leadership role in numerous clinical trials examining neurochemical selectivity, pharmacokinetics, and efficacy of both investigational and licensed medications in elderly people. He played a significant role in championing the FDA approval of the SSRI antidepressant citalopram (Celexa), going so far as to obtain his own investigational new drug license from the FDA to study the compound. Approved in European markets, but not in the United States, Lundbeck, the company responsible for the development of the SSRI, did not plan to seek approval for marketing in the United States.

Pollock, however, pursued the drug because of evidence that it was a highly selective serotonin reuptake inhibitor—he would go on to show that it is far more selective than any other SSRI available—and did not interfere with the cytochrome P450 pathways responsible for metabolism of the majority of newer medications available today.

Pollock suspected the drug would be of great benefit in treating depression and anxiety in the elderly, precisely because it would be safer with far fewer side effects and drug interactions. Today, the SSRI is one of the leading antidepressants available in the U.S. market and is used substantially in the geriatric setting, largely due to Pollock’s work.

During his Senior Investigator Award Lecture in Honolulu, Pollock described his more recent work with his team, centered on treating depression with comorbid medical illness in seniors.

"Rates of depression," Pollock said, "increase significantly in light of comorbid medical illness, and all medical illness looks worse in the face of depression."

Regardless, the primary question in geriatric psychopharmacology revolves around one issue: factors affecting drug concentration. And those factors are numerous, Pollock detailed. Seniors are less than half as likely to be actually taking their medications as prescribed, he said. In addition, there is sparse research to document pharmacokinetic differences of commonly prescribed medications in seniors.

"In fact, it is a serious public scandal! Even fluoxetine," Pollock noted, "which carries a geriatric indication, was approved for that population with only one study that had 11 volunteers. It really is shocking how little research we do have on this issue. The assumption is that these medications are OK in younger adults, so they should be OK in older adults."

Nothing could be further from the truth, he emphasized.

"Fully half of all drug-related mortality occurs in those over the age of 60," Pollock said. "And when you consider that only 13 percent of the population is over the age of 65, that 13 percent is consuming about 40 percent of all prescription medications. You should really consider it a form of treatable illness in its own right."

He noted that most drug adverse events and interactions are avoidable; the difficulty is "trying to manage the unintended effects of medications that we are giving seniors." ▪