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Antidepressants: Are they safe for anyone?

Kathleen Blanchard's picture

Antidepressants known as SSRIs are popular, but in elders, their use could result in higher risk of falls, seizures, hyponatremia or low sodium and other hazards, compared to tricyclics. Selective serotonin reuptake inhibitors were suggested in an observational study from University of Nottingham in England to raise the risk of stroke and all-cause mortality for people over age 65. Tricyclic antidepressants, however, appear to have the safest profile for elders.

Other new studies link higher risk of stroke from antidepressants, especially among women.

For the newest study, Carol Coupland, PhD, of the University of Nottingham and colleagues studied 60,746 individuals in the UK, 65 and older. The average age was 75. The study participants had been on antidepressant drugs for approximately one year. You can view more about the study here.

The most widely prescribed were SSRIs and then tricyclics: 54.7 and 31.7 percent respectively. “Other" antidepressants accounted for 13.5 percent of the prescriptions.

Average follow-up was 5 years. Approximately 59 percent of those studied were given an antidepressant.

All antidepressants over age 62 risky

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All antidepressants had higher risk of suicide, self-harm, falls with risk of fracture and bleeding in the GI tract, compared to no therapy. SSRIs were found to be riskiest for people over age 65. Trazodone, mirtazapine, and venlafaxine were linked to the worse outcomes in several of the categories examined by the research group.

According to Ian Hickie, MD, of the Brain and Mind Research Institute at the University of Sydney, "Although it is not necessary to seek a specialist opinion before starting treatment, clinicians, including those in primary care, need to be aware of the special circumstances surrounding the prescription of antidepressants to older people with depression (such as undetected cerebrovascular comorbidity, frequency and types of adverse events that can be life threatening).”

The study authors say patients and caregivers should be educated about the potential for harm from SSRIs and other antidepressants, especially during the first few weeks of treatment.

Since the study is observational, the authors say the best advice is for clinicians to remain aware that tricyclics, which can be prescribed in lower doses, may be safer for people over age 65. More studies are needed to understand confounding factors that may have contributed to the higher chances of dying, falling, experiencing a seizure or having a stroke that seems to be linked to antidepressants in general, and especially SSRIs.

Researchers from University of California have suggested treating depression with positive activity interventions.Given the recent findings that antidepressant have side effects for elders, middle-age women and the population in general that are coming to surface, seeking alternatives may be worthwhile.

Image credit: morguefile