Chronic illness often coexists with depression in elderly patients, along with frailty, possibly mitigating effects. 6 In the elderly, antidepressants have been associated with a fall risk similar to that with benzodiazepines. 7 Antidepressants might not be effective in treating depression in dementia. 8
How should we select antidepressants for older adults with increased fall risk?
In clinical practice, selecting an antidepressant in older adults having increased fall risk should be individualized, guided by both antidepressant-specific adverse effect and tolerability profiles and patient characteristics.
Do antidepressants increase falls risk in nursing home residents?
Older people are at high risk of falling after starting certain antidepressants. "We identified a small window of time when nursing home residents are at high risk of falls," says Sarah D. Berry, M.D., a coauthor of the study and an instructor in medicine at Harvard Medical School.
Are anti-depressants effective in preventing falls?
Antidepressants are equally effective, but differ in fall-related side effect profile. They contribute to (or cause) falling through orthostatic hypotension, sedation/impaired attention, hyponatremia, movement disorder and cardiac toxicity. Falling is an important driver of morbidity and mortality and, therefore, requires prevention.
What are the treatment options for mild depression in older fallers?
Consider exercise, particularly Tai Chi, and cognitive–behavioral therapy for the first-line treatment of mild depression in older fallers. When treating the older depressed patient, inquire about his or her adherence with osteoporosis and fracture-prevention guidelines. Open in a separate window Acknowledgments
Do antidepressants increase the risk of falls?
Although many older adults with symptoms of depression are not treated, the pharmacological treatment with antidepressants has also been consistently associated with risk of falls. Antidepressant use has been found to be associated with falls or fractures, with risks varying from 1.2- to 6-fold in older adults.
Which antidepressants should be avoided in the elderly?
Tricyclic antidepressants, especially amitriptyline and dothiepin,16 are known to pose a high risk of death in overdosage. These drugs should therefore be avoided in older people whose medication is not supervised and who are at risk of taking an overdose.
Why tricyclic antidepressants are used with caution in elderly patients?
Tricyclic antidepressants are no longer considered first-line agents for older adults given their potential for side effects, including postural hypotension, which can contribute to falls and fractures, cardiac conduction abnormalities, and anticholinergic effects.
Which of the following medications is most likely to increase fall risk in the elderly?
Antipsychotic medications, including haloperidol, olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole (Abilify), and risperidone (Risperdal), can increase fall risk due to syncope, sedation, slowed reflexes, loss of balance, and impaired psychomotor function.
Which drug should be avoided in geriatric patients?
AVOID Certain Anticholinergic DrugsAntidepressants amitriptyline (Elavil) and imipramine (Tofranil)Anti-Parkinson drug trihexyphenidyl (Artane)Irritable bowel syndrome drug dicyclomine (Bentyl)
Which antidepressant is least likely to cause hyponatremia?
Conclusions. All antidepressants except mianserin are associated with hyponatremia. The association is strongest with citalopram and lowest with duloxetine, venlafaxine and mirtazapine.
Why is amitriptyline not recommended for seniors?
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of amitriptyline in the elderly. However, elderly patients are more likely to have age-related liver problems, which may require an adjustment in the dose for patients receiving amitriptyline.
What are the precautions and contraindications for the tricyclic antidepressants?
Tricyclic antidepressants should be used cautiously in patients with seizures since they can increase the risk of seizures. Tricyclic antidepressants may worsen urinary retention (difficulty urinating) and narrow angle glaucoma.
Is amitriptyline OK for the elderly?
Tertiary amine tricyclics such as amitriptyline and imipramine have been reported to be effective in depressed geriatric patients, but because of their potential for side effects, it is not advisable to use them in the elderly.
What medications put you at risk for falls?
Medications that increase your risk of fallingAnti-anxiety drugs, such as diazepam (Valium) and lorazepam (Ativan)Diphenhydramine (Benadryl), an older antihistamine. ... Prescription medications to treat overactive bladder, such as oxybutynin (Ditropan) and tolterodine (Detrol).Tricyclic antidepressants.More items...
Which medication type is associated with an increased risk for a fall?
The authors presented a significant association between falls and the use of sedatives and hypnotics, antidepressants and benzodiazepines. The use of antidepressants had the strongest association with falls. Other drug classes have also been associated with an increased fall risk.
What are fall risk increasing drugs?
In the general population, a range of drugs have been identified as fall-risk-increasing drugs (FRIDs), e.g. antidepressants, anxiolytics, hypnotics and sedatives, and antipsychotics [12–17]. All of these drugs are commonly prescribed to people with ID [18, 19].
Does fluoxetine inhibit CYP2D6?
Of clinical relevance is the fact that initiation of antidepressants that potently inhibit the CYP2D6 enzyme (e.g. fluoxetine, paroxetine) in patients already on certain beta-blockers (CYP2D6 substrates), can lead to accumulation of the beta-blocker and associated bradycardia, hypotension, syncope, and falls [63].
Is mirtazapine safe for cardiovascular disease?
Bupropion and mirtazapine also appear to have little cardiovascular side effects [49]. Also, the newest generation antidepressants ( e.g. agomelatine and vortioxetine) appear to be safe regarding cardiovascular effects in adults, but literature on older and vulnerable individuals is limited.
Is agomelatine a fall prone drug?
Also, agomelatine use is associated with sleepiness. Therefore, agomelatine is not to be considered a drug of first choice in older (fall-prone) patients. SSRIs (and related drugs) have alerting properties and may cause nocturia, impairing sleep and subsequently daytime drowsiness [9].
Do antidepressants have a high risk of drug interactions?
In general, antidepressants are characterized by having a high risk of drug–drug interactions, obviously limiting treatment options in older individuals with comorbidity and polypharmacy. The tendency to cause drug–drug interactions however, varies considerably between antidepressants.
Can antidepressants cause dementia?
Off-label antidepressant use is highly prevalent, especially among those with dementia living in long-term care institutions [24]. In these elderly persons, antidepressants are frequently prescribed for behavioral and psychological symptoms of dementia (BPSD), such as anxiety, agitation, and sleeping disorders.
What is the best treatment for depression in the elderly?
Electroconvulsive therapy. Electroconvulsive therapy (ECT) is recommended as a first-line treatment for psychotic depression in the elderly, [ 17] with a recovery rate of over 80% and a faster and fuller response compared to medication. [ 16] .
What is the most common mental health problem in the elderly?
Depression is the most common mental health problem in the elderly [ 1] and is associated with a significant burden of illness that affects patients, their families, and communities and takes an economic toll as well. Prevalence studies suggest that 14% to 20% of the elderly living in the community experience depressive symptoms, ...
How long does it take for an antidepressant to go into remission?
In general, a 7- to 10-day tapering period is recommended for all antidepressants. If there is significant improvement but not full remission after 4 weeks on the optimized antidepressant, the recommendation is to wait another 4 weeks and then consider add-on treatment if remission is still not achieved. [ 1] .
Which SSRIs have the highest risk of drug interactions?
Venlafaxine, mirtazapine, and bupropion are also considered to have a good safety profile in terms of drug-drug interactions.16 SSRIs such as fluoxetine, paroxetine, and fluvoxamine have higher risks of drug-drug interactions.
Is venlafaxine safe for elderly?
The selective serotonin reuptake inhibitors (SSRIs) and the newer antidepressants buproprion, mirtazapine, moclobemide, and venlafaxine (a selective norepinephrine reuptake inhibitor or SNRI) are all relatively safe in the elderly.
Is Canmat safe for elderly?
However, the CANMAT recommendations are based on studies of younger adults and are not intended for the elderly. The use of atypical antipsychotics poses particular problems in older adults given the risk of extrapyramidal symptoms and falls as well as sedation, weight gain, dyslipidemia, and diabetes.
Is depression a problem for elderly people?
Depression in the elderly is a significant, common, and growing problem that requires treatment . It has serious implications for the patient, family, and community. Identification followed by a thorough assessment can help guide the selection of an appropriate antidepressant medication.
Does Duloxetine cause falls?
Duloxetine “most likely increases the risk of falls over longer treatment,” says Baker. “The goal of this publication is to identify medications that should either be avoided or used with caution in older adults,” says Baker. “While these are not specific recommendations for which medications to use to treat major depressive disorder in older ...
Can antidepressants cause falls?
Since many commonly prescribed antidepressants can lead to increased risk of falls, treating depression can be especially tricky in the elderly population. The study, published in the Journal of the American Geriatric Society, examined how treating Major Depressive Disorder (MDD) in adults over 65 with certain classes of antidepressants can lead ...
What is the best treatment for depression in fall prone individuals?
Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia.
What are the risk factors for falls?
Practice Points. Depression and fear of falling are independent risk factors for falls, each mediated through multifactorial pathways. Antidepressant medications are associated with a 70% increased risk of falls; SSRIs are associated with risk of fractures.
Why do older adults need to pay more attention to walking?
In particular, the cognitive domains of attention and executive function are central to gait performance.12In general, older adults need to allocate greater attention to walking to compensate for changes in their sensory and motor function.
What are the determinants of recurrent falls?
In one prospective study, there were four determinants of recurrent falls: postural sway, history of falls, handgrip strength, and depressive symptoms.7Individually , symptoms of depression may have a direct role in promoting falls.
What is the fear of falling?
Fear of falling and worries about the consequences of falling are common manifestations of anxiety in older adults and are associated with a variety of avoidance and safety behaviors.
What is the relationship between depression and falls?
The association between depression and falls involves factors related to the symptoms of depression, the treatment of depression, and the effect of falls on mood. The interaction is further complicated by common risk factors for falls and depression in older adults.
Does fear of falling increase risk of falls?
Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, ...
What is the most common medication used for depression?
Antidepressants are one of the most commonly prescribed drugs in the United States. In the 1990s, selective serotonin re-uptake inhibitors (SSRI) became the first line of drug treatment for depression, replacing tricyclic antidepressants (TCA)4.
Does TCA reduce dementia?
However, in a follow-up study, the authors reported that continued long-term treatment with older antidepressants, such as TCAs, was associated with a reduced rate of dementia, whereas continued treatment with other classes of antidepressants including SSRIs was not13.
Do antidepressants affect hippocampal volume?
A recent population-based study of older adults without dementia showed that antidepressants use was significantly associated with smaller total brain, smaller hippocampal, and larger white matter hyperintensity (WMH) volume, while high CES-D scores were not significantly associated with any of the brain measures24.
How long should you be treated for depression?
Older patients should be treated for at least a year from when clinical improvement is noted, and those with recurrent depression or severe symptoms should continue treatment indefinitely. Treatment of specific situations such as severe depression or depression with psychosis is discussed, including the use of electroconvulsive therapy.
What is indefinite treatment?
Indefinite treatment should be considered for patients who have severe depression, have a history of recurrent depression, require electroconvulsive therapy (ECT), or have only partial resolution of symptoms (D recommendation). Specific circumstances.
What is the goal of treatment?
The goal of treatment should be remission of symptoms. Improvement of symptoms can be monitored by identifying patient goals or by use of a clinical tool such as the Patient Health Questionnaire–9. Treatment should be considered in 3 phases: an acute treatment phase to achieve remission of symptoms, a continuation phase to prevent recurrence ...
What is the best treatment for depression in older adults?
APA's Clinical Practice Guideline recommends three psychotherapy interventions as well as a second-generation antidepressant (selective-serotonin reuptake inhibitors — SSRIs, selective-norepinephrine reuptake inhibitors — SNRIs or norepinephrine-dopamine reuptake inhibitors — NDRIs ) for the treatment ...
Why do older people need SSRIs?
Second-generation antidepressants (SSRIs, SNRIs or NDRIs) are recommended for older adults due to the reduced risk of side effects and safety in the event of overdose. If considering medication for older adults with depression, the panel recommends combining it with interpersonal psychotherapy.
What is the second generation of antidepressants?
Second-generation antidepressants (selective serotonin reuptake inhibitors — SSRIs, serotonin-norepinephrine reuptake inhibitors — SNRIs or norepinephrine/dopamine reuptake inhibitors — NDRIs) are recommended for older adults due to the reduced risk of side effects and safety in the event of overdose.
How many sessions of IPT should an older person take?
On average, older adults receive 16 to 20 weekly sessions of IPT. If considering this treatment for older adults with depression, the panel recommends augmenting with a second-generation antidepressant. IPT is recommended for the treatment of depression in older adults. How IPT can help treat depression in older adults.
What are the symptoms of depression?
Depression symptoms: Symptoms are seen as having both biological (e.g., sleep/wake functioning, eating patterns) and psychological (e.g., sadness; feelings of guilt) underpinnings . Social functioning: The way one interacts with significant others and responds to social situations.
How much venlafaxine is in Effexor?
venlafaxine (Effexor): 150-300 mg daily. Side effects and frequency of prescriber visits. Side effects of second-generation antidepressants are generally mild to moderate that can be tolerated or managed with over-the-counter remedies (e.g., headaches, nausea, drowsiness).
Is the information contained herein sufficient to enable one to become proficient in delivering these treatments?
The information contained herein is not sufficient to enable one to become proficient in delivering these treatments . Clinicians are encouraged to pursue training opportunities and, to become fully competent in new interventions, to receive consultation or supervision while first delivering the intervention.
What antidepressants increase the risk of falls?
These include Effexor, Trazodone, Wellbutrin and Remeron.
How long after SSRI medication can you fall?
Researchers looked specifically at falls recorded up to seven days after a medication change. Berry says it is not clear why the patient's risk of falling might increase with a change in the non-SSRI drugs, but it could have to do with the medication's effect on blood pressure or motor skills.
Can elderly people fall after taking antidepressants?
Older people are at high risk of falling after starting certain antidepressants. "We identified a small window of time when nursing home residents are at high risk of falls," says Sarah D. Berry, M.D., a coauthor of the study and an instructor in medicine at Harvard Medical School.
