Adverse outcomes with different antidepressant classes in the elderly

January 01, 0001

Adverse outcomes with different antidepressant classes in the elderly

These UK researchers examined adverse outcomes with antidepressant use in geriatric patients with depression. They performed a cohort study using data from the QResearch primary care database involving 60?746 participants aged 65 and up with a new episode of depression. They examined the occurrence of numerous adverse events with use of different classes of antidepressants.

The researchers found: "The associations with the adverse outcomes differed significantly between the antidepressant classes for seven outcomes. Selective serotonin reuptake inhibitors were associated with the highest adjusted hazard ratios for falls (1.66,) and hyponatraemia (1.52) compared with when antidepressants were not being used. The group of other antidepressants was associated with the highest adjusted hazard ratios for all cause mortality (1.66), attempted suicide/self harm (5.16), stroke/transient ischaemic attack (1.37), fracture (1.64), and epilepsy/seizures (2.24), compared with when antidepressants were not being used. Tricyclic antidepressants did not have the highest hazard ratio for any of the outcomes. Significantly different associations also existed between the individual drugs for the same seven outcomes- trazodone (tricyclic antidepressant), mirtazapine, and venlafaxine (both in the group of other antidepressants) were associated with the highest rates for some of these outcomes. Absolute risks over 1 year for all cause mortality were 7.04% for patients while not taking antidepressants, 8.12% for those taking tricyclic antidepressants, 10.61% for selective serotonin reuptake inhibitors, and 11.43% for other antidepressants."

The researchers concluded: "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."

This cohort trial suggests TCA’s may be the anti-depressant of choice for older patients, but further study is needed.

For the full abstract, click here.

BMJ 343:d4551, 2 August 2011
© 2011 BMJ Publishing Group Ltd.
Antidepressant use and risk of adverse outcomes in older people: population based cohort study. Carol Coupland, Paula Dhiman, Richard Morriss, Antony Arthur, Garry Barton, Julia Hippisley-Cox,. Correspondence to C Coupland:

Category: P. Psychological. Keywords: depression, elderly, geriatric, adverse events, tricyclic antidepressants, cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 26 August 2011

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