Antidepressant use and orthostatic hypotension in older adults living with mild‐to‐moderate Alzheimer disease

Abstract

Antidepressant use is often reported as a risk factor for Orthostatic Hypotension (OH), however this relationship has never been explored in those with mild/ moderate Alzheimer Disease (AD), who may represent a particularly vulnerable cohort. Methods: We performed a cross-sectional analysis of baseline data from the NILVAD study. Participants with mild-moderate AD were recruited from 23 centres in nine countries. Systolic and Diastolic Blood Pressure (SBP/DBP) was recorded in the seated position and after both 1 and 5 minutes of standing. OH was defined as a drop of ≥20 mmHg SBP/≥10 mmHg DBP. We examined the relationship between antidepressant use, orthostatic BP drop and the presence of OH, controlling for important covariates. Results: Of 509 participants (72.9 ± 8.3 years, 61.9% female), two-fifths (39.1%; 199/509) were prescribed a regular antidepressant. Antidepressant use was associated with a significantly greater SBP and DBP drop at 5 minutes (β: 1.83, 0.16-3.50, P = .03 for SBP; β: 1.13, 0.02-2.25, P < .05 for DBP). Selective Serotonin Reuptake Inhibitor (SSRI) use was associated with a significantly greater likelihood of OH (OR 2.0, 1.1-3.6, P = .02). Both findings persisted following robust covariate adjustment. Conclusions: In older adults with AD, antidepressants were associated with a significantly greater SBP/DBP drop at 5 minutes. SSRI use in particular may be a risk factor for OH. This emphasises the need to screen older antidepressant users, and particularly those with AD, for ongoing orthostatic symptoms in order to reduce the risk of falls in this vulnerable cohort.

A Case Study on Polypharmacy and Depression in a 75-Year-Old Woman with Visual Deficits and Charles Bonnet Syndrome

“…Exceptional cases of fatal overdose have been described. Its level of efficacy compared to SSRIs seems somewhat higher, even though the data are discrepant [ 33 , 34 , 35 , 36 , 37 , 38 ].…”

The Possible Application of Ketamine in the Treatment of Depression in Alzheimer’s Disease

“…A unique advantage of ketamine’s antidepressant action is the rapid and long-lasting effect, especially with (R)-ketamine, which poses less detrimental side effects than (R,S)-ketamine or (S)-ketamine [ 36 ]. Moreover, a significant incidence of orthostatic hypotension in this cohort had been reported with the administration of antidepressant therapy, especially with SSRIs [ 37 ]. On the other hand, increases in both systolic and diastolic blood pressure as well as heart rate with ketamine administration are evident with short-term intravenous ketamine administration [ 38 ].…”

An Update on Apathy in Alzheimer’s Disease

“…In addition to the aforementioned overlap with depression, the presence of other NPS such as psychosis, agitation or aggression may make it difficult in practice to appreciate the presence, and severity, of apathy [ 24 ]. Importantly, a significant number of individuals with AD may also be receiving psychoactive medications such as antidepressants, anticholinergic medications, antipsychotics and other medications that may confound the assessment and diagnosis of apathy syndrome in AD [ 25 , 26 , 27 ]. Finally, it may be difficult to fully distinguish between diminished goal-directed behaviour/motivation and loss of ability secondary to cognitive impairment, meaning that the presence of apathy syndrome often goes unrecognised in individuals with AD [ 13 ].…”