Antidepressant use and risk of adverse outcomes in older people: population based cohort study

Abstract

Selective serotonin reuptake inhibitors and drugs in the group of other antidepressants were associated with an increased risk of several adverse outcomes compared with tricyclic antidepressants. Among individual drugs, trazodone, mirtazapine, and venlafaxine were associated with the highest risks for some outcomes. As this is an observational study, it is susceptible to confounding by indication, channelling bias, and residual confounding, so differences in characteristics between patients prescribed different antidepressant drugs that could account for some of the associations between the drugs and the adverse outcomes may remain. Further research is needed to confirm these findings, but the risks and benefits of different antidepressants should be carefully evaluated when these drugs are prescribed to older people.

Depression and use of antidepressants in Swedish nursing homes: a 12-month follow-up study

“…Other antidepressants showed similar risks, but TCAs, produced fewer of these adverse effects (Coupland et al, 2011). In a Norwegian study discontinuation of antidepressant treatment in patients with dementia led to an increase in depressive symptoms (Bergh et al, 2012).…”

The Use of Antidepressants in Belgian Nursing Homes

“…Moreover, the large size of our sample makes it possible to extrapolate our findings to the entire Belgian nursing home setting. Similar prevalence numbers of depression and AD use were found in European [1,40] and American [9] studies, but for specific indication and dosage evaluation, no identical studies were available. The indications of AD prescribing were retrospectively collected by interviewing the GP.…”

“…Knowing that only major depressions should be treated pharmacologically, our results do not support the hypothesis of undertreatment in the group of residents with noted depression. Other recent articles also indicate an AD treatment percentage of more than 80% [9,40] for depressed residents, but these percentages are irrespective of indication. In addition to reporting that there is no undertreatment, it could also be useful to examine the reason why about a third of all residents need a pharmacological treatment of their depression.…”

“…Therefore, they are not recommended as a first choice to treat depression in older adults. However, a recent cohort study concluded that SSRIs and the newer ADs were associated with a higher risk of adverse events, such as stroke, fracture and all-cause mortality, compared with TCAs [40] .…”

Iatrogenia y prevención cuaternaria en salud mental

“…Cuando se usan en ancianos, hay un incremento de caídas, fracturas, morbili dad debida a hiponatremias, accidentes cerebrovasculares, infartos de miocardio, epilepsias, intentos de suicidio y más muer tes en general. Curiosamente, todos estos efectos adversos los producen en mayor medida los nuevos antidepresivos que los tricíclicos, probablemente porque los pri meros se utilizan a mayores dosis compara tivamente, debido a su aparente inocuidad 72 . En adolescentes aumentan el riesgo de sui cidio y conducta violenta 73 , lo que llevó a la Food an Drug Association (FDA) a obligar a las compañías a añadir una advertencia en la etiqueta (estudios en los que se basa y regu lación en: http://www.fda.gov/Drugs/Drug Safety/InformationbyDrugClass/UCM0962 73).…”