Concern over elderly antidepresssant use

  • Deborah Condon

The prescribing of antidepressants to older people needs to be carefully considered, as newer antidepressants may not be as safe for this population as previously thought, a new study suggests.

According to recent research, depression remains a significant public health problem across all parts of the world, affecting 121 million people, including up to 400,000 people in Ireland.

The condition is common among older people due to a number of specific risk factors, such as changes in roles and/or lifestyle, illness and hormonal changes triggered by the menopause.

UK researchers noted that there is very little known about the safety of new generation antidepressants in older people. These drugs are known as SSRIs (selective serotonin reuptake inhibitors) and include Seroxat and Prozac.

The researchers from the Universities of Nottingham and East Anglia decided to investigate any possible links between treatment with antidepressants and the risk of serious adverse outcomes in older people.

They looked at over 60,000 people aged 65 and older. All had been newly diagnosed with depression between 1996 and 2007.

The participants were monitored until the end of 2008. During that time, almost nine in 10 received at least one prescription for an antidepressant. Just over half of these prescriptions were for SSRIs, while one in three were for older antidepressants, known as tricyclic antidepressants (TCAs). The rest were prescribed other types of antidepressants.

The study then looked at the link between antidepressant use and a number of adverse outcomes, such as heart attack, stroke, attempted suicide, attempted self-harm, falls, fractures and epilepsy.

After taking into account other factors which may have influenced the results, the study found that SSRIs increased the risk of a number of adverse outcomes compared to TCAs.

This increased risk was also found among people who took other types of antidepressants.

Overall, SSRIs appeared to increase the risk of all-cause mortality, stroke, epilepsy or seizures, falls, fractures and hyponatraemia (high salt levels in the blood) when compared with TCAs.

Meanwhile the other antidepressants appeared to increase the risk of all-cause mortality, stroke, epilepsy or seizures, attempted suicide or self harm and fractures.

The researchers found that depressed people who were not taking any antidepressants had a 7% risk of dying during the next year. This risk rose to just over 8% for those taking TCAs. However, for those taking SSRIs, the risk increased to almost 11%, while those on other antidepressants had the greatest risk of dying during the following year, at just over 11%.

In terms of suffering an adverse outcome, the most risky time appeared to be during the first 28 days of antidepressant use, as well as the first 28 days after stopping the medication.

The researchers noted that one possible explanation for the findings is that TCAs were prescribed at lower doses than SSRIs. They called for further studies in this area.

However, they emphasised that the prescribing of these drugs to older people should be carefully considered and evaluated.

Details of these findings are published in the British Medical Journal.

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