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Drugs & Aging
Published in: Drugs & Aging 5/2009

01-05-2009 | Review Article

Antidepressants and Falls in the Elderly

Authors: Adam Darowski, Sally-Ann C. F. Chambers, David J. Chambers

Published in: Drugs & Aging | Issue 5/2009

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Abstract

Antidepressants have long been recognized as a contributory factor to falls and many studies show an association between antidepressants and falls. There are extensive data for tricyclic antidepressants (TCAs) and related drugs, and for selective serotonin reuptake inhibitors (SSRIs), but few data for other classes of antidepressants.
Sedation, insomnia and impaired sleep, nocturia, impaired postural reflexes and increased reaction times, orthostatic hypotension, cardiac rhythm and conduction disorders, and movement disorders have all been postulated as contributing factors to falls in patients taking antidepressants.
Sleep disturbance is a cardinal feature of depression, and all antidepressants have effects on sleep. TCAs and related drugs cause marked sedation with daytime drowsiness. SSRIs and related drugs have an alerting effect, impairing sleep duration and quality and causing insomnia, which may result in nocturia and daytime drowsiness. Daytime drowsiness is a significant risk factor for falls, both in untreated depression and in depression treated with antidepressants.
Clinically significant orthostatic hypotension is common with TCAs and related drugs, the older monoamine oxidase inhibitors and serotonin-norepinephrine reuptake inhibitors (SNRIs). It occurs less commonly with SSRIs, and rarely with moclobemide and bupropion, and is not reported as a significant adverse effect of hypericum (St John’s wort).
Cardiac rhythm and conduction disturbances are well recognized with TCAs, tetracyclics and SNRIs, but have also been reported with SSRIs. The contribution of antidepressant-induced conduction and rhythm disturbances to falls cannot be assessed with current data.
There are insufficient data to exonerate any individual antidepressant or class of antidepressants as a potential cause of falls. The magnitude of the increased risk of falling with an antidepressant is about the same as the excess risk found in patients with untreated depression.
Literature
1.
Mittmann N, Herrmann N, Einarson TR, et al. The efficacy and safety of antidepressants in late life depression: a metaanalysis. J Affect Disord 1997; 46: 191–217PubMedCrossRef
2.
Whooley MA, Kip KE, Cauley JA, et al. Depression, falls, and risk of fracture in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1999; 159: 484–90PubMedCrossRef
3.
Turcu A, Toubin S, Mourey F, et al. Falls and depression in older people. Gerontology 2004; 50: 303–8PubMedCrossRef
4.
Asplund R, Johansson S, Henriksson S, et al. Nocturia, depression and antidepressant medication. BJU Int 2005; 95(6): 820–3PubMedCrossRef
5.
Thapa PB, Gideon P, Cost TW, et al. Antidepressants and the risk of falls among nursing home residents. N Engl J Med 1998; 339: 875–82PubMedCrossRef
6.
Hubbard R, Farrington P, Smith C, et al. Exposure to tricyclic and selective serotonin reuptake inhibitor anti-depressants and the risk of hip fracture. Am J Epidemiol 2003; 158: 77–84PubMedCrossRef
7.
Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: 1. Psychotropic drugs. J Am Geriatr Soc 1999; 37: 30–9
8.
Liu B, Anderson G, Mittmann N, et al. Use of selected serotonin reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. Lancet 1998; 351: 1303–7PubMedCrossRef
9.
Vestergaard P, Rejnmark L, Mosekilde L. Anxiolytics, sedatives, antidepressants, neuroleptics and the risk of fracture. Osteoporos Int 2006; 17: 807–16PubMedCrossRef
10.
Kelly KD, Pickett W, Yiannakoulias N, et al. Medication use and falls in community-dwelling older persons. Age Ageing 2003; 32: 503–9PubMedCrossRef
11.
Ray WA, Griffin MR, Malcolm E. Cyclic antidepressants and the risk of hip fracture. Arch Intern Med 1991; 151: 754–6PubMedCrossRef
12.
Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross-sectional study. BMJ 2003; 327: 712–7PubMedCrossRef
13.
Ebly EM, Hogan DB, Fung TS. Potential adverse outcomes of psychotropic and narcotic drug use in Canadian seniors. J Clin Epidemiol 1997; 50(7): 857–63PubMedCrossRef
14.
Ensrud KE, Blackwell TL, Mangione CM, et al. Central nervous system: active medications and risk for falls in older women. J Am Geriatr Soc 2002; 50: 1629–37PubMedCrossRef
15.
Arfken CL, Wilson JG, Aronson SM. Retrospective review of selective serotonin reuptake inhibitors and falling in older nursing home residents. Int Psychogeriatr 2001; 13(1): 85–91PubMedCrossRef
16.
Lewis CE, Ewing SK, Taylor BC, et al. Predictors of nonspine fracture in elderly men: the MrOS study. J Bone Miner Res 2007; 22: 211–9PubMedCrossRef
17.
Kallin K, Gustafson Y, Sandman P, et al. Drugs and falls in older people in geriatric care settings. Aging Clin Exp Res 2004; 16(4): 270–6PubMed
18.
Souchet E, Lapeyre-Mestre M, Montastruc JL. Drug related falls: a study in the French Pharmacovigilance database. Pharmacoepidemiol Drug Saf 2005; 14: 11–6PubMedCrossRef
19.
Vassallo M, Sharma JC, Allen SC. Characteristics of single fallers and recurrent fallers among hospital inpatients. Gerontology 2002; 48: 147–50PubMedCrossRef
20.
Richelson E, Nelson A. Antagonism by antidepressants of neurotransmitter receptors of normal human brain in vitro. J Pharmacol Exp Ther 1984; 230: 94–102PubMed
21.
Cusack B, Nelson A, Richelson E. Binding of antidepressants to human brain receptors: focus on newer generation compounds. Psychopharmacology (Berl) 1994; 114: 559–65CrossRef
22.
Stage KB, Kragh-Sjorensen P. Age-related adverse drug reactions to clomipramine. Acta Psychiatr Scand 2002; 105: 55–9PubMedCrossRef
23.
Robinson DS, Nies A, Corcella J, et al. Cardiovascular effects of phenelzine and amitriptyline in depressed outpatients. J Clin Psychiatry 1982; 43: 8–15PubMed
24.
Biswas P, Wilton LV, Shakir SA. The pharmacovigilance of mirtazapine: results of a prescription event monitoring study on 13554 patients in England. J Psychopharmacol 2003; 17: 121–6PubMedCrossRef
25.
Muldoon C. The safety and tolerability of citalopram. Int Clin Psychopharmacol 1996; 11Suppl. 1: 35–40PubMedCrossRef
26.
Barak Y, Swartz M, Levy D, et al. Age-related differences in the side-effect profile of citalopram. Prog Neuropsychopharmacol Bio Psychiatry 2003; 27: 545–8CrossRef
27.
Grimsley SR, Jann MW. Paroxetine sertraline, and fluvoxamine: new selective serotonin reuptake inhibitors. Clin Pharm 1992; 11(11): 930–57PubMed
28.
29.
Trick L, Stanley N, Rigney U, et al. A double-blind, randomized, 26-week study comparing the cognitive and psychomotor effects and efficacy of 75 mg (37.5 mg b.i.d.) venlafaxine and 75 mg (25 mg mane, 50 mg nocte) dothiepin in elderly patients with moderate major depression 393 being treated in general practice. J Psychopharmacol 2004; 18(2): 205–14PubMedCrossRef
30.
Brunnauer A, Laux G, Geiger E, et al. Antidepressants and driving ability: results from a clinical study. J Clin Psychiatry 2006; 67(11): 1776–81PubMedCrossRef
31.
Krystal AD, Thase ME, Tucker VL, et al. Bupropion HCl and sleep in patients with depression. Curr Psychiatry Rev 2007; 3(2): 123–8CrossRef
32.
Asplund R, Henriksson S, Johansson S, et al. Nocturia and depression. BJU Int 2004; 93(9): 253–6CrossRef
33.
Teo JSH, Briffa NK, Devine A, et al. Do sleep problems or urinary incontinence predict falls in elderly women? Aust J Physiother 2006; 52: 19–24PubMedCrossRef
34.
Asplund R, Johansson S, Svante H, et al. Nocturia, depression and antidepressant medication. BJU Int 2005; 95: 820–3PubMedCrossRef
35.
Goldman SE, Stone KL, Ancoli-Israel S. Poor sleep is associated with poorer physical performance and greater functional limitations in older women. Sleep 2007; 30(10): 1317–24PubMed
36.
Ensrud KE, Blackwell TL, Ancoli-Israel S, et al. Use of selective serotonin reuptake inhibitors and sleep disturbances in community-dwelling older women. J Am Geriatr Soc 2006; 54(10): 1508–15PubMedCrossRef
37.
Mayers AG, Baldwin DS. Antidepressants and their effect on sleep. Hum Psychopharmacol 2005; 20(8): 533–59PubMedCrossRef
38.
Li X, Hamdy R, Sandborn W, et al. Long-term effects of antidepressants on balance, equilibrium and postural reflexes. Psychiatry Res 1996; 63: 191–6PubMedCrossRef
39.
Fairweather DB, Kerr JS, Harrison DA, et al. A double blind comparison of the effects of fluoxetine and amitriptyline on cognitive function in elderly depressed patients. Human Psychopharmacol 1993; 8: 41–7CrossRef
40.
Laghrissi-Thode F, Pollock BG, Miller M, et al. Comparative effects of sertraline and nortriptyline on body sway in older depressed patients. Am J Geriatr Psychiatry 1995; 3: 228–37CrossRef
41.
Mamo DC, Pollock MD, Mulsani B, et al. Effects of nortriptyline and paroxetine on postural sway in depressed elderly patients. Am J Geriatr Psychiatry 2002; 10(2): 199–205PubMed
42.
Draganich LF, Zacny J, Klafta J, et al. The effects of anti-depressants on obstructed and unobstructed gait in healthy elderly people. J Gerontol A Biol Sci Med Sci 2001; 56(1): M36–41PubMedCrossRef
43.
Heitterachi E, Lord SR, Meyerkort P, et al. Blood pressure changes on upright tilting predict falls in older people. Age Ageing 2002; 31: 181–6PubMedCrossRef
44.
Graafmans WC, Ooms ME, Hofstee HMA, et al. Falls in the elderly: A prospective study of risk factors and risk profiles. Am J Epidemiol 1996; 142(11): 1129–36CrossRef
45.
Poon IO, Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 2005; 30: 173–8PubMedCrossRef
46.
Ooi W, Hossain M, Lipsitz LA. The association between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med 2000; 108: 106–11PubMedCrossRef
47.
Hayes JR, Born GF, Rosenbaum AH. Incidence of orthostatic hypotension in patients with primary affective disorders treated with tricyclic antidepressants. Mayo Clin Proc 1977; 52: 509–12PubMed
48.
Glassman AH, Bigger JT, Giardina EV, et al. Clinical characteristics of imipramine induced orthostatic hypotension. Lancet 1979; 1(8114): 468–72PubMedCrossRef
49.
Glassman AH, Bigger JT. Cardiovascular effects of therapeutic doses of tricyclic antidepressants: a review. Arch Gen Psychiatry 1982; 38: 815–20CrossRef
50.
Glassman AH. Cardiovascular effects of antidepressant drugs: updated. Int Clin Psychopharmacol 1998; 13Suppl. 5: S25–30PubMedCrossRef
51.
Glassman AH, Johnson LL, Giardina EV, et al. The use of imipramine in depressed patients with congestive cardiac failure. JAMA 1983; 250(15): 1997–2001PubMedCrossRef
52.
Roose SP, Glassman AH, Giardina EV, et al. Nortriptyline in depressed patients with left ventricular impairment. JAMA 1986; 256(23): 3253–7PubMedCrossRef
53.
Miller MD, Pollock BG, Rifai AH, et al. Longitudinal analysis of nortriptyline side effects in elderly depressed patients. J Geriatr Psychiatry Neurol 1991; 4: 226–30PubMedCrossRef
54.
Farid FF, Wenger TL, Tsai SY, et al. Use of bupropion in patients who exhibit orthostatic hypotension on tricyclic antidepressants. J Clin Psychiatry 1983; 44 (5 Pt 2): 170–3PubMed
55.
Roose SP, Dalack GW, Glassman AH, et al. Cardiovascular effects of bupropion in depressed patients with heart disease. Am J Psychiatry 1991; 148(4): 512–6PubMed
56.
Moller M, Thayssen P, Kragh-Sorensen P, et al. Mianserin: cardiovascular effects in elderly patients. Psychopharmacology 1983; 80: 174–7PubMedCrossRef
57.
Coupland NJ, Wilson SJ, Potokar JP, et al. A comparison of the effects of phenelzine treatment with moclobemide treatment on cardiovascular reflexes. Int Clin Psychopharmacol 1995; 10: 229–38PubMedCrossRef
58.
Rabkin JG, Quitkin M, Harrison W, et al. Adverse reactions to monoamine oxidase inhibitors: part 1. A comparative study. J Clin Psychopharmacol 1984; 4: 270–8PubMedCrossRef
59.
Stage KB. Orthostatic side effects of clomipramine and moclobemide during treatment for depression. Nord J Psychiatry 2005; 59: 298–301PubMedCrossRef
60.
Koczkas C, Holm A, Karlsson A, et al. Moclobemide and clomipramine in endogenous depression: a randomised clinical trial. Acta Psychiatr Scand 1989; 79: 523–9PubMedCrossRef
61.
Delini-Stula A, Baier D, Kohnen R, et al. Undesirable blood pressure changes under naturalistic treatment with moclobemide, a reversible MAO-A inhibitor: results of the drug utilization observation studies. Pharmacopsychiatry 1999; 32: 61–7PubMedCrossRef
62.
Joo BA, Lenze EJ, Mulsant BH, et al. Risk factors for falls during treatment of late life depression. J Clin Psychiatry 2002; 63(10): 936–41PubMedCrossRef
63.
64.
Johnson EM, Whyte E, Mulsant BH, et al. Cardiovascular changes associated with venlafaxine in the treatment of late life depression. Am J Geriatr Psychiatry 2006; 14(9): 796–802PubMedCrossRef
65.
Kok R, Nolen W, Heeren T. Cardiovascular changes associated with venlafaxine in the treatment of late life depression [letter]. Am J Geriatr Psychiatry 2007; 15(8): 725PubMedCrossRef
66.
Wernicke J, Lledo A, Raskin J, et al. An evaluation of the cardiovascular safety profile of duloxetine: findings 394 from 42 placebo-controlled studies. Drug Saf 2007; 30(5): 437–55PubMedCrossRef
67.
Raskin J, Wiltse CG, Dinkel JJ, et al. Safety and tolerability of duloxetine at 60 mg once daily in elderly patients with major depressive disorder. J Clin Psychopharmacol 2008; 28(1): 32–8PubMedCrossRef
68.
Berzewski H, Van Moffaert M, Gagiano CA. Efficacy and tolerability of reboxetine compared with imipramine in a double-blind study in patients suffering from major depressive episodes. Eur Neuropsychopharmacol 1997; 7Suppl. 1: S37–47PubMedCrossRef
69.
Versiani M, Amin M, Chouinard G. Double-blind, Placebo-controlled study with reboxetine in inpatients with severe major depressive disorder. J Clin Psychopharmacol 2000; 20: 28–34PubMedCrossRef
70.
Witchel HJ, Hancox JC, Nutt DJ. Psychotropic drugs, cardiac arrhythmia, and sudden death. J Clin Psychopharmacol 2003; 23: 58–77PubMedCrossRef
71.
Pacher P, Kecskemeti V. Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns. Curr Pharm Des 2004; 10: 2463–75PubMedCrossRef
72.
Roose SP, Glassman AH, Giardina EV, et al. Tricyclic anti-depressants in depressed patients with cardiac conduction disease. Arch Gen Psychiatry 1987; 44(3): 273–5PubMedCrossRef
73.
Gambassi G, Incalzi R. Atrioventricular blocks associated with citalopram. Am J Geriatr Psychiatry 2005; 13(10): 918–9PubMed
74.
Gardner SF, Rutherford WF, Munger MA, et al. Drug-induced supraventricular tachycardia: a case report of fluoxetine. Ann Emerg Med 1991; 20: 194–7PubMedCrossRef
75.
McAnally LE, Threlkeld KR, Dreyling CA. Case report of a syncopal episode associated with fluoxetine. Ann Pharmacother 1992; 26(9): 1090–1PubMed
76.
Ellison JM, Milofsky JE, Ely E. Fluoxetine-induced bradycardia and syncope in two patients. J Clin Psychiatry 1990; 51(9): 385–6PubMed
77.
Feder R. Bradycardia and syncope induced by fluoxetine. J Clin Psychiatry 1991; 52(3): 139PubMed
78.
Cherin P, Colvez A, Deville de Perriere GD, et al. Risk of syncope in the elderly and consumption of drugs: a case control study. J Clin Epidemiol 1997; 50(3): 313–20PubMedCrossRef
79.
Sleeper R, Bond CA, Rojas-Fernandez C. Psychotropic drugs and falls: new evidence pertaining to serotonin reuptake inhibitors. Pharmacotherapy 2000; 20: 308–17PubMedCrossRef
80.
81.
Williams LJ, Henry MJ, Berk M, et al. SSRI use and bone mineral density in women with a history of depression. Int Clin Psychopharmacol 2008; 23(2): 84–7PubMedCrossRef
82.
Haney EM, Chan BK, Diem SJ, et al. Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch Intern Med 2007; 167(12): 1246–51PubMedCrossRef
83.
Diem SJ, Blackwell TL, Stone KL, et al. Use of anti-depressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med 2007; 167(12): 1240–5PubMedCrossRef
84.
Demyttenaere K, Jaspers L. Bupropion and SSRI-induced side effects. J Psychopharmacol 2008; 22(7): 792–804PubMedCrossRef
85.
Beyens MN, Guy C, Mounier G, et al. Serious adverse reactions of bupropion for smoking cessation: analysis of the French Pharmacovigilance Database from 2001 to 2004. Drug Saf 2008; 31(11): 1017–26PubMedCrossRef
86.
Mayers AG, Baldwin DS. Antidepressants and their effect on sleep. Hum Psychopharmacol 2005; 20(8): 533–59PubMedCrossRef
Metadata
Title
Antidepressants and Falls in the Elderly
Authors
Adam Darowski
Sally-Ann C. F. Chambers
David J. Chambers
Publication date
01-05-2009
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 5/2009
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.2165/00002512-200926050-00002

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