Elderly Taking SSRI Antidepressants More Prone To Falls

The elderly taking certain antidepressants are more prone to falls, according to recent research in the British Journal of Clinical Pharmacology.

We’ve long written about issues with the elderly, including nursing home patients, who are prescribed selective serotonin reuptake inhibitor (SSRI) antidepressants and risks for adverse events. This most recent study found that nursing home residents with dementia who receive average SSRI doses are three times likelier to suffer a serious fall versus patients not on the drugs, said OnMedica.

The study revealed that the higher the dose, the greater the injury risk following the fall, although the link was present at low doses. Because many nursing home residents with dementia also suffer from depression, SSRIs are often the treatment of choice, said OnMedica.

Researchers recorded daily drug use and daily falls in 248 residents diagnosed with dementia from 2006 to 2009. Data was derived from a prescription database and a standardized incident report system. A dataset of 85,074 person days was collected, the average age of participants was 82, and prescription records indicated that antidepressants were used 13,729 (16.1 percent) days—SSRIs were specifically taken on 11,105 of those days, said OnMedica.

Of the 248 residents, 152 (61.5 percent) sustained 683 falls, which translates into about 2.9 falls per person-year; 38 had a single fall, but 114 fell frequently. Of the falls, 220 caused injury: 10 hip fractures; 11 other fractures; 198 graze, open wound, sprain, bruise, and swelling injuries; and one death. Serious fall risks increased two-to-three-fold depending on patient age and SSRI dosage and frequency, noted the British Journal of Clinical Pharmacology.

“Staff in residential homes are always concerned about reducing the chance of people falling and I think we should consider developing new treatment protocols that take into account the increased risk of falling that occurs when you give people SSRIs,” said lead author, Carolyn Shanty Sterke, of the Section of Geriatric Medicine at Erasmus University Medical Center, Rotterdam, The Netherlands, wrote OnMedica. “Our study also discovered that the risk of an injurious fall increased even more if the residents were also given hypnotic or sedative drugs as sleeping pills,” she added. “Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses,” she concluded, said OnMedica.

We recently wrote that SSRIs have been linked to cardiac birth defects, increased risks for Autism Spectrum Disorders, and breast and ovarian cancers, and that a newer study found that SSRIs such as Prozac (fluoxetine) and Effexor (venlafaxine), might not be the most effective or safest choice when treating seniors for depression, posing greater potential for more side effects than older antidepressants. SSRIs also include Celexa (citalopram), Paxil (paroxetine), and Zoloft (sertraline), which are popularly used to treat depression in the senior population; however, only a few clinical trials have reviewed SSRI safety and efficacy in this group.

This team reviewed prescription data on over 60,000 patients aged 65 to 100 who were recently diagnosed with depression and found that about 89 percent received one or multiple antidepressant prescriptions: 57 percent received one SSRI, 31 percent received one tricyclic antidepressant, and the remainder were taking other antidepressants.

The study found that seniors taking SSRIs had an increased risk of dying, suffering a stroke, falling, breaking a bone, or having seizures, versus seniors not on an antidepressant. In one year, 10.6 percent of seniors taking an SSRI—Effexor, Remeron (mirtazapine), and Desyrel (trazodone)—suffered the greatest risks, which were especially high in the first month after starting and in the month following discontinuation of the drug.