In conclusion, elderly depressed patients treated with antidepressants may be at reduced risk of attempting suicide. These findings need support from prospective randomized trials. INTRODUCTION The most significant risk factors for attempted suicide include mood disorders and a history of suicide attempts.
Full Answer
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.
When should antidepressants be discontinued in fall-prone elderly persons?
If clinical condition allows, withdrawal of antidepressants is recommended in fall-prone elderly persons.
How can we reduce falls in the elderly due to drugs?
Numbers of FRIDs and ODs were correlated with the total number of drugs dispensed. Interventions to reduce falls in the elderly by focusing on reducing the total number of drugs and withdrawal of psychotropic medications might improve the quality and safety of drug treatment in primary care.
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.
Why do antidepressants increase risk of falls?
Tricyclic antidepressants (TCAs) are thought to contribute to falls because of their sedative and orthostatic hypotension properties. The exact mechanisms by which selective serotonin reuptake inhibitors (SSRIs) contribute to falls are not known, and the literature is mixed on their relative safety related to falls.
Why tricyclic antidepressants are not recommended for 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 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.
Which medication is most associated with increased falls in the elderly population?
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.
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.
Why Prozac is not good for elderly?
Gurvich and Cunningham state in their article1 on psychotropic drugs in nursing homes that fluoxetine (Prozac) is not recommended in the geriatric population because of its longer half-life of active metabolite relative to other selective serotonin reuptake inhibitors (SSRIs), resulting in the potential for a longer ...
Is it safe for elderly to take antidepressants?
Studies have found that while antidepressants can be helpful in older adults, they may not always be as effective as in younger patients. Also, the risk of side effects or potential reactions with other medicines must be carefully considered.
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 drug is the first choice for treating depression in older adults?
Applies to escitalopram and citalopram: Generally well tolerated. Non-sedating, low risk of sleep disturbance, comparatively few significant drug interactions. Good choice for initial treatment of depression in most older adults.
Which drugs cause falls in elderly?
Medications that affect the brain (“psychoactives“)Benzodiazepines. ... Non-benzodiazepine prescription sedatives. ... Antipsychotics. ... Anticonvulsants/Mood-stabilizers. ... Antidepressants. ... Opioid (narcotic) analgesics. ... Anticholinergics. ... Antihypertensives.More items...
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 classes should be used with caution in older adults with history of falls?
Medication classes commonly implicated in falls:Sedative/hypnotics.Antipsychotics.Antidepressants.Anticholinergics.Cardiac medications.Pain medications.Anticonvulsants.
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.
How common is antidepressant use in older people?
Antidepressant use is also common in older persons; almost 10% of community-dwelling older people [ 6 ], and one-third of nursing home residents use antidepressants [ 11 ]. With age, adverse outcomes of antidepressant use, including premature death, are highly prevalent [ 6 ].
Which antidepressant has the lowest inhibitory activity?
Of the newer antidepressants, fluoxetine, fluvoxamine, and paroxetine have high risk of drug–drug interactions, whereas citalopram and sertraline have a low inhibitory activity on different drug metabolizing enzymes [ 62 ].
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.
Do TCAs increase fracture risk?
TCAs may also increase fracture risk, but through mechanisms other than a direct effect on bone mineral density [ 61 ]. Based on current (but scarce) evidence, antidepressants other than SSRIs and TCAs do not appear to increase fracture risk [ 61 ].
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.
Can you prescribe antidepressants in fall prone elderly?
(De-) prescribing antidepressants in fall-prone older adults is often challenging, but detailed insight in fall-related side effect profile of the different antidepressants and a recently developed expert-based decision aid STOPPFalls assists prescribers in clinical decision-making.
Can antidepressants cause falls?
Untreated depression and antidepressant use both contribute to fall risk. 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. If clinical condition allows, withdrawal of antidepressants is recommended in fall-prone elderly persons. An important barrier is reluctance of prescribers to deprescribe antidepressants resulting from fear of withdrawal symptoms or disease relapse/recurrence, and the level of complexity of deprescribing antidepressants in older persons with multiple comorbidities and medications. Practical resources and algorithms are available that guide and assist clinicians in deprescribing antidepressants.
Can antidepressants cause falls?
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.
Does depression affect gait?
Anything that has an adverse effect on gait and balance might be expected to make falls more probable. Depression itself might have an effect by causing diminished activity, deconditioning, psychomotor retardation, nocturia or impaired sleep.
Can you interview a patient who is taking an antidepressant?
It is common to interview a patient in the falls clinic who is taking an antidepressant without being aware of it and with no idea of its indication. Determining the reasons for the antidepressant prescription, and the duration of therapy, may lead to a decision to reduce or stop the drug. When an antidepressant is not being given for depression, an alternative treatment (if one is still needed) may be found.
Does Venlafaxine cause orthostatic hypotension?
Venlafaxine has been found to cause orthostatic hypotension in a significant percentage of patients, and can cause rhythm disorders and some sedation. There are no data concerning falls directly, but SNRIs are SSRIs with additional noradrenaline re-uptake inhibition, and might be expected to have a similar risk to other SSRIs in this respect.
Is SSRI as good as TCA?
The initial data showing that the risk of falls and fractures in patients taking an SSRI is as great as that in patients taking a TCA have been reproduced consistently in a number of studies in different settings.
Can trazodone cause falls?
TCAs, tetracyclics and trazodone might be expected to cause falls by virtue of their adverse effect profile , which is attributable to their effects on histamine receptors and α-adrenoceptors. They all cause sedation and sleep disturbance with daytime sleepiness, which might be expected to slow reaction times. They all cause orthostatic hypotension. They have arrhythmogenic effects and should be avoided in the presence of myocardial ischaemia.
Is it safe to take antidepressants for elderly?
There is no antidepressant that has been proven to be safe in terms of its falls risk in the elderly. Changes are often made to antidepressant prescriptions when there is an obvious adverse effect (such as orthostatic hypotension or drowsiness) that is thought to be contributing to falls, but there is no evidence that such a strategy makes a difference to the falls risk. The greatest effect on falls is likely to be achieved by withdrawing antidepressant medication whenever there is no good indication for its continued use.
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.
What is the most common cause of injuries and hospital admissions in the elderly?
Falls are the most common cause of injuries and hospital admissions in the elderly. The Swedish National Board of Health and Welfare has created a list of drugs considered to increase the fall risk (FRIDs) and drugs that might cause/worsen orthostatism (ODs). This cross-sectional study was aimed to assess FRIDs and their correlation ...
What percentage of the 369 included patients were women?
Seventy-six percent of the 369 included patients were women and the mean age was 87.4 (SD 5.7) years. A majority (76%) were living in nursing homes. Table 2 shows the baseline data for the patients.
Abstract
Treatment with selective serotonin reuptake inhibitors (SSRIs) may increase the risk of impulsive acts including suicide, while data from epidemiological studies suggest that the effect of SSRIs in the elderly may be beneficial.
INTRODUCTION
The most significant risk factors for attempted suicide include mood disorders and a history of suicide attempts. Suicide risk is assessed along a continuum from suicidal ideation alone to completed suicide. Although the incidence of suicide is low in the general population, it was among the leading causes of death in the Western world in 2000.
METHOD
There are no private emergency psychiatric facilities in Israel, and all acute psychiatric hospitalizations are regional and reported to the Ministry of Health.
RESULTS
During the study period, 205 elderly MDD were hospitalized at the Abarbanel Mental Health Center psycho-geriatric division following a suicide attempt. Of these, 101 MDD patients fulfilled all inclusion criteria and are the index group of the present analysis.
DISCUSSION
The present study indicates that elderly patients treated with antidepressants, mainly SSRIs, are significantly less likely to have attempted to commit suicide within the month previous to hospitalization for MDD than a cohort matched for age and sex.
Acknowledgements
This study was supported by an unrestricted research grant from H Lundbeck A/S.