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SSRIs vs Fall Risk in Elderly Part 2

Posted Jan 24 2012 3:01am
Well, I think I just opened Pandora's box , at least for myself.  I'm sure most of you were already well aware of the risks of selective serotonin reuptake inhibitors (SSRIs) compared to other antidepressants, especially in the elderly.  Apparently, I'm a bit late to the party.  In his presentation today on women & depression, Dr. B. Wayne Blount pointed out that SSRIs were linked to an increase risk of falls in the elderly in a prospective cohort study published in last August in BMJ .  Boy, do I feel embarrassed!  I missed this article just 3 days prior to our summer meeting !   Mea culpa .  

So what's so important about this study?  The authors followed for up to 10 years a cohort of over 60,000 newly diagnosed depressed elderly adults avg 75yo two-thirds of whom were women.  Close to 90% received some antidepressant for their condition.  After taking into account drug, dose & duration of use, SSRIs were associated with an increase risk of falls by 67% while tricyclic antidepressants (TCAs) were associated with a 30% increase risk of falls, both compared to not taking any antidepressant at all.  With regards to fractures, TCAs were associated with a 26% increase risk while SSRIs were associated with a 58% increase risk, again both compared to not taking any antidepressant at all.  And with regards to all-cause mortality, TCAs were associated with a 16% increase risk while SSRIs were associated with a 54% increase risk, both compared to not taking any antidepressant at all.

What's the bottom line?  Being depressed is pretty miserable but while antidepressants might improve one's mood, SSRIs might not be as safe as TCAs in the long run as we once thought vis a vis falls, fractures & all-cause mortality, such that there's more to safety than serotonin syndrome and overdose-induced cardiac dysrhythmias.  So make sure you have an informed discussion with both the patient and family, educate them on the risks & benefits of medication vs psychotherapy alone, and provide close follow up (especially if the patient chooses an antidepressant).
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