High Risk of Adverse Outcomes Tied to SSRI Use in Elderly

Increased risk with selective serotonin reuptake inhibitors, other drugs than tricyclic antidepressants

WEDNESDAY, Aug. 3 (HealthDay News) -- In older individuals with depression, use of selective serotonin reuptake inhibitors (SSRIs) and certain other antidepressants is associated with higher risk of adverse outcomes than tricyclic antidepressants (TCAs), according to a study published online Aug. 2 in BMJ.

Carol Coupland, Ph.D., from the University of Nottingham in the United Kingdom, and colleagues investigated the association between antidepressant treatment and the risk of several potential adverse outcomes in 60,746 individuals (age 65 to 100 years) with depression. They examined the risk by dose, duration of use, and class of antidepressants. Participants were recruited from 1996 to 2007, and followed up until 2008. The adjusted hazard ratios (HRs) associated with antidepressant use for several adverse outcomes were the main outcome measure.

The investigators found that 1,398,359 antidepressant prescriptions were issued, and 89 percent of the patients received at least one prescription during follow-up. Of these, 54.7, 31.6, 0.2, and 13.5 percent were for SSRIs, TCAs, monoamine-oxidase inhibitors, and other antidepressants, respectively. Compared with non-use of antidepressants, SSRIs were associated with highest adjusted HRs for falls and hyponatremia, while highest adjusted HRs for all-cause mortality, attempted suicide/self-harm, stroke/transient ischemic attack, fracture, and epilepsy/seizures were seen with other groups of antidepressants. TCAs did not have highest rates for any outcome; whereas, trazodone, mirtazapine, and venlafaxine correlated with highest HRs for some outcomes. Absolute risks over one year for all-cause mortality were 7.04 for those not taking antidepressants, and 8.12, 10.61, and 11.43 percent for patients on TCAs, SSRIs, and other antidepressants, respectively.

"SSRIs and drugs in the group of other antidepressants were associated with an increased risk of several adverse outcomes compared with tricyclic antidepressants," the authors write.

One of the study authors disclosed a financial relationship with a medical software company, and one of the study authors disclosed financial ties to the pharmaceutical industry.

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