First-line Antidepressants Linked To Lower Fall Risk In Older Patients With Depression

First-line antidepressants may help lower the risk of falls and fall-related injuries in older patients with depression, according to a study published today in JAMA Network Open.

Grace Hsin-Min Wang, Pharm.D., M.S., of the University of Florida, Gainesville, and colleagues examined claims data amassed from 101,953 Medicare beneficiaries age 65 or older who received a diagnosis of depression in 2017 or 2018.

Overall, 45.2% of the individuals did not receive any treatment for their depression (the control group), while 14.6% received psychotherapy. Among those who were prescribed first-line antidepressants, 9.2% took sertraline, 9% took escitalopram, 4.7% took citalopram, 3.8% took mirtazapine, 3.1% took duloxetine, 2.9% took trazodone, 2.8% took fluoxetine, 2.3% took bupropion, 1.4% took paroxetine, and 1.0% took venlafaxine. To recognize that real-world clinical practice may not involve immediate treatment, the researchers allowed for a 90-day grace period for treatment initiation following depression diagnosis.

The individuals were then followed for one year from the date of diagnosis or until the earliest fall and related injury after diagnosis, death, entry into hospice or a skilled nursing facility, changing to Medicare Advantage, switching or combining their treatments with other treatments, or discontinuing treatment—whichever came first. Falls and related injuries included outcomes such as bone fractures, sprains, strains, dislocations, and superficial skin injuries.

Compared with adults receiving no treatment, those receiving psychotherapy did not demonstrate any increased or decreased risk of falls or related injuries. However, compared with no treatment, taking first-line antidepressants was associated with a lower risk of falls as follows:

• Bupropion and paroxetine: 26% lower risk
• Venlafaxine: 25% lower risk
• Duloxetine, fluoxetine, mirtazapine, and trazodone: 22% lower risk
• Citalopram and sertraline: 19% lower risk
• Escitalopram: 17% lower risk

The researchers noted that their results contradict those of previous studies that suggested antidepressants may increase the risk of falls and related injuries because of anticholinergic side effects such as orthostatic hypotension, sedation, and syncope. They said some potential reasons for these different findings may be that other studies included adults without depression in the control group and did not allow for a grace period for treatment initiation.

“Although there have been concerns about [falls and related injury] risk associated with these treatments in older adults, our findings suggest that standard first-line depression treatments do not exacerbate FRI risk, indicating their safety for initiation in older adults newly diagnosed with depression,” Wang and colleagues wrote. “However, it remains crucial for clinicians to consider the full spectrum of potential adverse effects and customize treatment plans to ensure a balance between effectiveness and risks.”

For related information, see the American Journal of Psychiatry article “Real-World Evidence on Clinical Outcomes of Commonly Used Antidepressants in Older Adults Initiating Antidepressants for Depression: A Nationwide Cohort Study in Denmark.”

(Image: Getty Images/iStock/Toru Kimura)

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