Abstract
Previous studies have reported a higher risk of falls among tricyclic antidepressant (TCA) users compared to selective serotonin reuptake inhibitor (SSRI) users, yet SSRIs are known as a safer antidepressant class for use in older adults. This study examined the effects of antidepressant use on the risk of fall-related injuries after classifying antidepressant drugs, polypharmacy, and central nervous system (CNS) drugs by therapeutic classes and identifying factors influencing risk of fall-related injuries. A retrospective matched cohort study based on propensity scores was conducted among older adults, aged 70–89 years, who initiated antidepressant use between 1 January 2012 and 31 December 2014 using the national health insurance system senior cohort in Korea. The proportional hazard Cox regression model was used to examine the association between fall-related injuries and antidepressants. The subgroup analyses were performed to assess the risk of fall-related injuries by the number of concurrently administered medications, therapeutic classes of antidepressants, and CNS class medications. This study found that duloxetine, escitalopram, paroxetine, amitriptyline, imipramine, and trazodone significantly increased the risk of fall-related injuries in older adults. When antidepressants were prescribed to older adults, prescribers carefully considered factors including the dose, number of concurrently administered medications, and therapeutic classes of CNS.
Highlights
The choice of antidepressant in clinical practice is based on patient preferences and the safety profile of the drug [1,2]
Paroxetine, trazodone, and imipramine users had high risks, which correlated well with their known pharmacological properties: paroxetine has anticholinergic and antihistaminergic activity linked with more sedation compared to other selective serotonin reuptake inhibitor (SSRI); imipramine is associated with a higher incidence of orthostatic hypotension, which can contribute to a higher risk of fall-related injuries; and trazodone is known for dizziness and sedation by blocking alpha1 adrenergic and histaminergic receptors [2,4,31]
This study concluded that the risk of fall-related injuries was significantly increased by the use of antidepressants, including duloxetine, escitalopram, paroxetine, amitriptyline, imipramine, and trazodone, in older Korean adults
Summary
The choice of antidepressant in clinical practice is based on patient preferences and the safety profile of the drug [1,2]. Caution is needed for older adults who are vulnerable to potential drug-related adverse events. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are considered to be a relatively safe antidepressant choice and are recommended over tricyclic antidepressants (TCAs) for older adults [2,3]. Previous observational studies have reported the consistent association of the risk of falls or fall-related injuries with SSRI and SNRI users, which was often higher than that of TCA users [5–9]. A multinational cohort study by Tamblyn et al (2020) reported the association between fractures and SSRI use in several countries
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