(RxWiki News) Depression is common among the elderly with many electing to take antidepressants. The new generation of antidepressants may be overly risky for older patients.
"Talk to your doctor about which antidepressant is most suitable."
Dr. Carol Coupland, associate professor in medical statistics at the University of Nottingham's division of primary care, said that research indicates that older tricyclic antidepressants may be associated with lower risk of adverse outcomes for the elderly. She said the finding was unexpected, and called for additional research to validate the findings.
Researchers found that serotonin reuptake inhibitors (SSRIs) are more strongly associated with increased risks in individuals over the age of 65 as compared to tricyclic antidepressants. They suggest that doctors carefully consider the benefits and risks when prescribing antidepressants to older patients.
SSRIs are routinely prescribed to older patients, but very little was known about the safety of such drugs among the elderly.
Researchers identified 60,746 patients over the age of 65 that resided in the United Kingdom. The patients had a newly diagnosed episode of depression between 1996 and 2007. Some had other conditions such as heart disease or diabetes and were taking several medications.
Investigators found that 89 percent, or 54,038, received at least one prescription for an antidepressant. About 57 percent were for SSRIs, 31 percent for tricyclic drugs and the remainder were for other types of medications.
Antidepressant use was then scrutinized against adverse outcomes including all-cause mortality, attempted suicide or self harm, heart attack, stroke, falls, fractures, epilepsy or seizures and high salt levels in the blood. After adjusting for various factors, researchers determined that SSRIs were associated with an increased risk of adverse outcomes compared to other types of antidepressants.
Overall, patients had a 7.1 percent risk of dying over a year if not taking antidepressants. They had a 8.1 percent chance of dying while taking tricyclics, a 10.6 percent risk while taking SSRIs and an 11.4 percent chance while taking other antidepressants, though this group included a mix of drugs.
Among individual drugs, trazodone, mirtazapine and venlafaxine carried the highest risk for some adverse outcomes. Patients were most likely to be affected by adverse events in the first 28 days of stopping or starting antidepressants. Researchers noted that the tricyclics were prescribed at lower doses, which could explain part of the disparity.
The research was published through the National Institute of Health Research.