September 25, 1998

New antidepressants don’t reduce elderly falls: study

New antidepressants don't reduce elderly falls: study

Contrary to conventional wisdom, a newer ‹ and more expensive ‹ breed of antidepressant medication does little to reduce the odds that elderly patients being treated for depression will suffer painful, injurious falls.

In a study published yesterday in the New England Journal of Medicine, Wayne A. Ray, Ph.D., professor of Preventive Medicine at Vanderbilt University Medical Center, showed there was little difference in rates of falls experienced by nursing home residents treated with traditional, tricyclic antidepressants and those treated with newer, more costly selective-serotonin-reuptake inhibitors.

The problem of antidepressants and the increased risk of falls is a major concern. According to Ray, there are approximately 250,000 nursing home residents nationwide currently using antidepressants. Residents of long-term care facilities ‹ even those not taking antidepressants ‹ are highly susceptible to falls and their related injuries, with rates up to three times those of community-dwelling elderly persons.

For those who are taking antidepressants, the risk of injurious falls rises anywhere from 50 percent to 200 percent.

The use of tricyclic and other heterocyclic antidepressants ‹ which produce side effects such as psychomotor impairment and orthostasis ‹ is associated with the increased risk of falls among nursing home residents. By avoiding some of these side effects, it was assumed that selective-serotonin-reuptake-inhibitors would be a safer way of treating depression among those at high risk for falls. These types of antidepressants ‹ known by such names as fluoxetine, sertraline and paroxetine ‹ can be several times as expensive as tricyclic drugs such as nortriptyline, amitriptyline, imipramine and doxepin.

In his study of 2,428 Tennessee nursing home residents, Ray found this was not the case. The difference in rate of falls was negligible, and it was concluded that the preferential use of the newer antidepressants was not likely to reduce the rate of falls among nursing home residents who take antidepressants. In fact, the study's results suggest that it's the depression itself ‹ not which type of antidepressants used to treat the condition ‹ that makes elderly sufferers more susceptible to falls.

"We have known for some time that older patients who took antidepressants had higher rates of falls," Ray said. "Many thought that the drugs themselves could be responsible, as tricyclic antidepressants produce sedation and orthostasis, which could plausibly cause falls.

"However, our study shows the rates of falls among nursing home residents using either tricyclic antidepressants or selective serotonin reuptake inhibitor antidepressants are very similar. This suggests that, in the nursing home population, the cause of falls may be related to the depression per se, and the higher rate of falls among antidepressant users will not be materially altered by choice of drug," Ray said.

The study tracked new users of tricyclic antidepressants, new users of selective serotonin reuptake inhibitors and a control group of non-users of antidepressants. It was found that new users of the tricyclic antidepressants had a rate of falls during therapy that was twice that of non-users of antidepressants, and there was a pronounced dose-response relation.

Meanwhile, the group of new users of selective seratonin reuptake inhibitors also had a rate of falls that was 80 percent higher than that of non-users, and these rates also increased with increased dosage. While these types of antidepressants may not help reduce the likelihood of falls, there was some evidence that they were safer for nursing home residents with more severe cardiovascular disease.

The Centers for Disease Control and Prevention, as well as the Food and Drug Administration, helped fund Ray's study.