When taking a first-line antidepressant medication, older adults with depression are less likely to experience a fall with injuries when compared with their untreated peers, according to a study published Monday in JAMA Network Open.
Study participants included about 102,000 Medicare fee-for-service beneficiaries aged 65 years or older who were newly diagnosed with depression. Data came from Medicare claims made between 2016 and 2019.
The study investigated one year of treatment in patients who participated in psychotherapy, or who took first-line antidepressant drugs, including sertraline, escitalopram, citalopram, mirtazapine, duloxetine, trazodone, fluoxetine, bupropion, paroxetine and venlafaxine.
The risk of falls and related injuries averaged 63 per 1,000 person-years for patients treated with bupropion compared with 87 per 1,000 person-years for patients who were untreated. Psychotherapy use was not associated with a lower risk of falls and related injuries.
The findings contrast with those from previous studies, the authors reported. Past studies have shown that antidepressant use may increase the risk of falls and related injuries “due to their anticholinergic adverse effects, such as orthostatic hypotension, sedation, and syncope (fainting),” they noted. The authors pointed to differences in study populations and study design among the possible reasons for the contrasting findings.
The researchers also found that 45% of participants diagnosed with depression did not receive psychotherapy or antidepressants within the first 90 days of their diagnosis, highlighting the relative lack of depression treatment in this age group, they said.
Despite ongoing concerns about the risk of falls with related injuries linked to antidepressant treatments in older adults, the new findings “suggest that standard first-line depression treatments do not exacerbate” this risk, “indicating their safety for initiation in older adults newly diagnosed with depression,” the authors concluded.
Nevertheless, they cautioned that clinicians should consider all potential adverse effects of these treatments and to create customized treatment plans that balance effectiveness and risks for their patients.
