Depression drugs cut falls risk

Antidepressants lower the risk of falling, suggesting their benefits outweigh the potential harms.

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Older people taking first-line antidepressants have a lower risk of falling and hurting themselves, according to an analysis of almost 102,000 people over 65 with depression.

The cohort study found that compared to no treatment, first-line antidepressants were associated with a lower falls and injury risk, with a reduced risk ranging from 36% for bupropion to 17% for escitalopram.

Psychotherapy alone for depression was not associated with a reduced falls risk, the researchers said.

They used Medicare data to measure time to first fall and related injuries (FRI), including bone fractures, sprains, strains, dislocations and skin injuries.

“We observed a decreased FRI rate and restricted mean survival time in patients receiving antidepressants compared with the untreated individuals, indicating that depression itself could be the main contributor to FRI,” the researchers said in JAMA Network Open.

“Consequently, this supports the hypothesis that the clinical benefits of antidepressants in managing depression may outweigh the risks associated with their anticholinergic adverse effects that contribute to FRI.”

The researchers said their study contrasted with previous research that found antidepressants increased falls risk “due to their anticholinergic adverse effects, such as orthostatic hypotension, sedation, and syncope”.

Among the participants, 45.2% had not had any treatment at all, and 14.6% only had psychotherapy. The most common antidepressants used were sertraline (9%), escitalopram (9%), citalopram (4.7%), mirtazapine (3.8%), duloxetine (3.1%), trazodone (2.9%), fluoxetine (2.8%), bupropion (2.3%), paroxetine (1.4%), and venlafaxine (1%).

The researchers said previous research had shown that depression-related symptoms – such as executive dysfunction, cognitive impairment, lack of sleep, poor diet and reduced exercise – increased the risk of falls and related injuries.

The researchers noted that 45% of participants had not received psychotherapy or antidepressants within 90 days of their diagnosis.

“These findings underscore the critical consequences of untreated depression, which can lead to cognitive decline, increased suicide risk, higher mortality rates, and reduced quality of life. Antidepressants and psychotherapy, the mainstays of depression treatment, have been proven to significantly alleviate depressive symptoms.

“Although there have been concerns about FRI risk associated with these treatments in older adults, our findings suggest that standard first-line depression treatments do not exacerbate FRI risk, indicating their safety for initiation in older adults newly diagnosed with depression.”

JAMA Network Open, 26 August 2024