Antidepressant Use, Depressive Symptoms, and Incident Frailty in Women Aged 65 and Older from the Women's Health Initiative Observational Study

Abstract

Objectives To examine the associations of depressive symptoms, antidepressant use, and duration of use with incident frailty three years later in nonfrail women ≥ age 65. Design Secondary analysis of the Women’s Health Initiative Observational Study (WHI-OS), a prospective cohort study. Setting WHI-OS was conducted in 40 U.S. clinical centers. Participants Women aged 65-79, not frail at baseline. Measurements Antidepressant use was assessed through medication container inspection at baseline. We created four groups according to baseline use and Burnam depression screen (range 0-1, 0.06 cut-off): antidepressant non-users without depressive symptoms (referent group), antidepressant non-users with depressive symptoms, antidepressant users without depressive symptoms, and antidepressant users with depressive symptoms. Frailty components included slowness/weakness, exhaustion, low physical activity, and unintended weight loss, ascertained through self-report and physical measurements at baseline and year 3. Results Among 27652 women at baseline, 4.9% (n=1350) were antidepressant users and 6.5% (n=1794) were categorized depressed. At year 3, 14.9% (n=4125) were frail. All groups had an increased risk for incident frailty compared to the referent group. Odds ratios ranged from 1.73 (95% Confidence Interval (CI) =1.41-2.12) among non-depressed antidepressant users to 3.63 among depressed antidepressant users (95% CI = 2.37-5.55). All durations of use were associated with incident frailty (<1 year OR = 1.95, 95% CI = 1.41-2.68; 1 to 3 years OR = 1.99, 95% CI = 1.45-2.74; > 3 years OR = 1.60, 95% CI = 1.20-2.14). Conclusion In older adult women, depressive symptoms and antidepressant use were associated with frailty after 3 years follow-up.

Vascular depression and frailty: a compound threat to longevity among older-old women

“…This hypothesis was supported by Lakey et al's (2012) research on middle-aged and older adults. Our earlier study (Paulson & Lichtenberg, in press) using the same sample as this study, concluded that over a 4-year interval, elders with both high CVB and probable depression have a greater risk of both prevalent and incident frailty than did those with either high CVB or probable depression alone.…”

Sex Differences in the Construct Overlap of Frailty and Depression: Evidence from the Health and Retirement Study

“…In addition to shared pathology, there are other mechanisms that may explain the depression-frailty relationship. Lakey and colleagues found that antidepressant use predicted incident frailty among older women independent of depressive symptoms (30). …”

“…The final, best-fitting model was used to compare symptom endorsement profiles across gender. All latent class models were estimated using Mplus software (30). …”

Antidepressants are Independently Associated with Gait Deficits in Single and Dual Task Conditions

“…Dual task gait deficits predict falls (20), and are important as this task represents the complex but more realistic challenges encountered in daily life. Several studies have linked anti-depressant use to an increased risk of falls, fractures and frailty (5,17,29). Gait deficits associated with anti-depressant use could potentially mediate this relationship, and the paucity of current research highlights the need to examine this further.…”

“…However, the few studies that adjusted for confounders such as socio-demographics, cognitive function and health (10,11,13) found that independent effects were limited to reduced gait speed and stride length and increased swing time variability (10,13). Anti-depressants are commonly prescribed to older adults and are associated with an increased fall risk independent of depressive symptoms (5,17). This increased risk may be mediated by gait impairments, however, the effect of anti-depressant use on gait is conflicting and limited to a few studies with sample sizes of less than twenty (9,18,19).…”