A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database

Coupland, Carol; Dhiman, Paula; Barton, Garry; Morriss, Richard; Arthur, Antony; Sach, Tracey; Hippisley‐Cox, Julia

doi:10.3310/hta15280

Cited by 100 publications

(117 citation statements)

References 183 publications

(142 reference statements)

Supporting

Mentioning

107

Contrasting

Order By: Relevance

“…Thus, a possible explanation for our results and previously observed associations is indication bias, that is, the condition for which the drug was prescribed rather than the drug itself increasing the risk (Coupland et al 2011a). Certain depressive symptoms such as difficulties in concentration, fatigue and insomnia can lead to an increased risk of injury.…”

Section: Possible Mechanismsmentioning

confidence: 52%

Antidepressant use and work-related injuries

et al. 2016

View full text Add to dashboard Cite

Background. Adverse effects of antidepressants are most common at the beginning of the treatment, but possible also later. We examined the association between antidepressant use and work-related injuries taking into account the duration of antidepressant use.Method. Antidepressant use and work-related injuries between 2000 and 2011 were measured among 66 238 employees (mean age 43.8 years, 80% female) using linkage to national records (the Finnish Public Sector study). We analysed data using time-dependent modelling with individuals as their own controls (self-controlled case-series design).Results. In 2238 individuals who had used antidepressants and had a work-related injury during a mean follow-up of 7.8 years, no increase in the risk of injury was observed in the beginning of antidepressant treatment. However, an increased injury risk was seen after 3 months of treatment (rate ratio, compared with no recent antidepressant use, 1.27, 95% confidence interval 1.10-1.48). This was also the case among those who had used only selective serotonin reuptake inhibitors (n = 714; rate ratio 1.41, 95% confidence interval 1.08-1.83).Conclusions. Antidepressant use was not associated with an increased risk of work-related injury at the beginning of treatment. Post-hoc analyses of antidepressant trials are needed to determine whether long-term use of antidepressants increases the risk of work-related injury.

show abstract

Section: Possible Mechanismsmentioning

confidence: 52%

Antidepressant use and work-related injuries

et al. 2016

View full text Add to dashboard Cite

show abstract

“…[62][63][64] Hyponatremia is also associated with SSRI use, primarily in elderly patients with other risk factors for hyponatremia. 65 SSRIs can inhibit platelet aggregation by altering platelet serotonin receptors and modestly increase the risk of gastrointestinal bleeding, but this risk may be doubled with concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs). 66 Concomitant use of acid-suppressing drugs can significantly reduce the risk of gastrointestinal bleeding.…”

Section: 61mentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

et al. 2016

View full text Add to dashboard Cite

Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Methods: Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. ''Pharmacological Treatments'' is the third of six sections of the 2016 guidelines. With little new information on older medications, treatment recommendations focus on second-generation antidepressants.Results: Evidence-informed responses are given for 21 questions under 4 broad categories: 1) principles of pharmacological management, including individualized assessment of patient and medication factors for antidepressant selection, regular and

show abstract

“…(14–17, 45, 47–58) Several of these studies showed that SSRI users had other risk factors that may be associated with frailty such as multiple comorbidities, higher number of medications(15, 16), baseline higher rate of falls(48), or higher age (i.e. the oldest old).…”

Section: Resultsmentioning

confidence: 99%

Cause or Effect? Selective Serotonin Reuptake Inhibitors and Falls in Older Adults: A Systematic Review

Gebara

Lipsey

Karp

et al. 2015

The American Journal of Geriatric Psychiatry

View full text Add to dashboard Cite

A 2012 update of the Beers criteria categorizes selective serotonin reuptake inhibitors (SSRIs) as potentially inappropriate medications in all older adults based on fall risk. The application of these recommendations, not only to frail nursing home residents, but also to all older adults, may lead to changes in health policy or clinical practice with harmful consequences. A systematic review of studies on the association between SSRIs and falls in older adults was conducted to examine the evidence for causation. Twenty-six studies met the inclusion criteria. The majority of studies were observational and suggest an association between SSRIs and falls. The direction of the relationship – causation or effect- cannot be discerned from this type of study. Standardized techniques for determining likely causation were then used to see if there was support for the hypothesis that SSRI’s lead to falls. This analysis did not suggest causation was likely. There is no Level 1 evidence that SSRIs cause falls. Therefore, changes in the current treatment guidelines or policies on the use of SSRIs in older adults based on fall risk may not be justified at this time given the lack of an established evidence base. Given its significance to public health, well-designed experimental studies are required to address this question definitively.

show abstract

A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database

Cited by 100 publications

References 183 publications

Antidepressant use and work-related injuries

Antidepressant use and work-related injuries

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

Cause or Effect? Selective Serotonin Reuptake Inhibitors and Falls in Older Adults: A Systematic Review

Contact Info

Product

Resources

About