<p>Antidepressants and the risk of traumatic brain injury in the elderly: differences between individual agents</p>

Abstract

Objective To determine the association of individual antidepressants (ADs) with the risk of traumatic brain injury (TBI) in the elderly. Patients and methods We conducted a case–control study nested in a cohort of new users of ADs aged ≥65 years, identified in the German Pharmacoepidemiological Research Database during 2005–2014. Cases were patients first hospitalized for TBI. Up to 100 controls per case were selected using incidence density sampling. AD use was ascertained at the index date based on the supply of last dispensing (adding 150% of the defined daily doses [DDDs]; in sensitivity analysis, no additional DDDs were considered). We estimated adjusted ORs (aORs) and 95% CIs using conditional logistic regression. Results Among 701,309 cohort members, 16,750 cases were identified and matched to 1,673,320 controls (in both groups: 70.4% women; median age 80 years). Compared with remote users of the same AD, current users had an aOR (95% CI) of 1.87 (1.56–2.24) for duloxetine, 1.74 (1.41–2.15) for escitalopram, 1.70 (1.58–1.83) for citalopram, 1.66 (1.40–1.97) for sertraline, 1.64 (1.24–2.15) for fluoxetine and 1.57 (1.20–2.06) for paroxetine. The aOR was lower for amitriptyline (1.45; 1.32–1.58), trimipramine (1.17; 0.99–1.38) and opipramol (1.11; 0.99–1.25). Mirtazapine had an aOR of 1.03 (0.94–1.12). Sensitivity analysis confirmed the findings. Conclusion The large variability between individual ADs shows the importance of considering the safety of individual agents rather than focusing on class alone.

How often are antidepressants prescribed off‐label among older adults in Germany? A claims data analysis

“…When treating insomnia or pain, physicians may tend to assume that antidepressants in the same class have similar risk‐benefit ratios and therefore prescribe them irrespective of whether or not they are licensed for the respective indication. However, there is increasing evidence suggesting a relevant variation in the risk profile between individual antidepressants within one class 37–39 . Furthermore, the risk of drug‐drug interactions may vary between individual antidepressants.…”

“…However, there is increasing evidence suggesting a relevant variation in the risk profile between individual antidepressants within one class [37][38][39]. Furthermore, the risk of drugdrug-interactions may vary between individual antidepressants.…”

“…However, there is increasing evidence suggesting a relevant variation in the risk profile between individual antidepressants within one class. [37][38][39] Furthermore, the risk of drug-drug interactions may vary between individual antidepressants. For example, the concomitant use of the TCAs clomipramine or imipramine with certain opioids can-similarly to SSRIslead to the partially life-threatening serotonin syndrome, while this is not the case for other TCAs such as amitriptyline, doxepine or trimipramine.…”

<p>Individual Antidepressants and the Risk of Fractures in Older Adults: A New User Active Comparator Study</p>

“…Differences between individual ADs regarding the risk of falls and consequences of falls such as fractures 7,8 and traumatic brain injuries 33 have consistently been reported, but the underlying mechanism is still unclear. Although almost all ADs may cause side effects that increase susceptibility to falls (eg sedation, dizziness, orthostatic hypotension), 54 and thus increase the risk of fractures, the intensity of such effects may vary.…”

“…25,27,28 GePaRD has been used for various types of pharmacoepidemiological studies including drug utilization studies in the elderly 29,30 and studies investigating the risks of antidepressants. 27,[31][32][33]…”