The Impact of First-Line Antidepressants on Fall Risk in Older Adults

Antidepressants are commonly used to treat depression in older adults, but there has been concern regarding their potential impact on fall risk. A recent cohort study by Wei-Hsuan Lo-Ciganic and colleagues at the University of Pittsburgh investigated the association between first-line antidepressants and the risk of falls and related injuries among older adults.

The study included over 100,000 Medicare beneficiaries who were newly diagnosed with depression. The use of first-line antidepressants was found to be associated with a decreased risk of falls and related injuries compared to no treatment. Specifically, bupropion and escitalopram were linked to the lowest hazard ratios for fall risk.

Patients treated with bupropion had lower event rates for falls and related injuries compared to those who did not receive treatment. The restricted mean survival time was also longer for individuals treated with bupropion. Additionally, psychotherapy was not associated with an increased risk of falls and related injuries.

The 2019 American Geriatrics Society Beers Criteria had recommended against using antidepressants in older adults due to concerns about side effects such as drowsiness and balance problems. However, the current study suggests that first-line antidepressants may actually reduce the risk of falls in this population.

The findings of this study provide important safety information for clinicians when considering different first-line antidepressant treatments for older adults. It challenges previous recommendations and highlights the importance of treating depressive symptoms in this population.

Despite the promising results, the study had several limitations. Data collection challenges may have led to an underestimate of fall cases, and unmeasured factors such as lifestyle and environment were not accounted for in the analysis.

Overall, the study by Lo-Ciganic and colleagues sheds light on the complex relationship between antidepressants and fall risk in older adults. Further research is needed to fully understand the impact of different antidepressants on this vulnerable population.