Antidepressants and Fracture Risk in Older Adults: A Comparative Safety Analysis

Gagne, JJ; Patrick, AR; Mogun, Helen; Solomon, D. H.

doi:10.1038/clpt.2011.54

Cited by 54 publications

(50 citation statements)

References 34 publications

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“…Consistent with this, use of SSRIs, but not tricyclic antidepressants, was associated with increased rates of bone loss at the hip in older women [32] and men [33]. Some studies suggest that SSRIs may be associated with greater risk of fracture than TCAs, postulating a specific serotonergic effect on bone physiology [34,35]. Another study found that the risk of osteoporotic fracture was significantly higher for current use of antidepressant with a high affinity for 5-HT transporter (all SSRIs agents) compared to those with a medium or low affinity (like TCAs) [36].…”

Section: Discussionsupporting

confidence: 52%

Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS)

et al. 2014

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Summary-We used data from a large, prospective Canadian cohort to assess the association between selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) and fracture. We found an increased risk of fractures in individuals who used SSRI or SNRI, even after controlling for multiple risk factors.Introduction-Previous studies have suggested an association between SSRIs and increasing risk of fragility fractures. However, the majority of these studies were not long-term analyses or were performed using administrative data and, thus, could not fully control for potential confounders. We sought to determine whether the use of SSRIs and SNRIs is associated with increased risk of fragility fracture, in adults aged 50+.

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Section: Discussionsupporting

confidence: 52%

Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS)

et al. 2014

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“…Even in patients with major depression, the benefits of treatment in routine treatment settings fall short of those reported in randomized clinical trials [58]. Inappropriate use of antidepressant medications is especially of concern in the older adults who are prone to drug-drug interactions [59,60,61,62]. …”

Section: Discussionmentioning

confidence: 99%

Clinician-Identified Depression in Community Settings: Concordance with Structured-Interview Diagnoses

Mojtabai

2013

Psychother Psychosom

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Background: Relatively little is known about the prevalence and correlates of overdiagnosis of depression in community settings. This study examined the extent to which individuals with clinician-identified depression in the community meet the criteria for DSM-IV major depressive episodes (MDE) and characteristics of these individuals. Methods: In a sample of 5,639 participants with clinician-identified depression drawn from the 2009-2010 United States National Survey of Drug Use and Health, the proportion of participants who met the 12-month MDE criteria, ascertained by a structured interview, and variations in MDE diagnosis across different groups of participants were examined. Mental health profiles and service use of participants who met the MDE criteria were compared to those who did not meet these criteria. Results: Only 38.4% of participants with 12-month clinician-identified depression met the 12-month MDE criteria. Older adults were less likely than younger adults to meet the criteria - only 14.3% of those 65 years old or older met the criteria, whereas participants with more education and those with poorer overall health were more likely to meet the criteria. Participants who did not meet the 12-month MDE criteria reported less distress and impairment in role functioning and used fewer services. A majority of both groups, however, were prescribed and used psychiatric medications. Conclusions: Depression overdiagnosis and overtreatment is common in community settings in the USA. There is a need for improved targeting of diagnosis and treatments of depression and other mental disorders in these settings.

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“…(7, 8) Side-effects constitute a large public health burden which disproportionately falls on elderly patients. Older adults have less physiologic reserve than younger patients (7) and SSRI treatment has specifically been associated with weight gain, (9) concentration and attention impairment, (10, 11) falls, (12–14) syndrome of inappropriate antidiuretic hormone secretion (SIADH),(3) and serotonin syndrome (15) in this population. In addition to more severe side-effects that happen rarely, common, less severe side-effects also play an important role in patient adherence to SRIs.…”

Section: Objectivementioning

confidence: 99%

Common Selective Serotonin Reuptake Inhibitor Side Effects in Older Adults Associated with Genetic Polymorphisms in the Serotonin Transporter and Receptors: Data from a Randomized Controlled Trial

Garfield

Dixon

Nowotny

et al. 2014

The American Journal of Geriatric Psychiatry

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Objective Antidepressant side-effects are a significant public health issue, associated with poor adherence, premature treatment discontinuation and in rare cases significant harm. This is especially relevant for older adults, who assume the largest and most serious burden of medication side-effects. We investigated the association between antidepressant side-effects and genetic variation in the serotonin system in anxious, older adults participating in a randomized, placebo-controlled trial of the SSRI escitalopram. Method Adults (n=177) aged ≥ 60 years were randomized to active treatment or placebo for 12-weeks. Side-effects were assessed using the UKU side effect rating scale. Genetic polymorphisms were putative functional variants in the promoters of the serotonin transporter and 1A and 2A receptors (5-HTTLPR (L/S + rs25531), HTR1A rs6295, HTR2A rs6311, respectively). Results Four significant drug-placebo side-effect differences were found, including increased duration of sleep, dry mouth, diarrhea and diminished sexual desire. Analyses using putative high- vs low-transcription genotype groupings revealed 6 pharmacogenetic effects: greater dry mouth and decreased sexual desire for the low- and high-expressing genotypes of the serotonin transporter, respectively, and greater diarrhea with the low-transcription genotype of the 1A receptor. Diminished sexual desire was experienced significantly more in those with high-expressing genotype and either the serotonin transporter, 1A or 2A receptors. There was not a significant relationship between drug concentration and side-effects nor a mean difference in drug concentration between low- and high-expressing genotypes. Conclusion Genetic variation in the 5HT system may predict who develops common SSRI side-effects and why. More work is needed to further characterize this genetic modulation and to translate research findings into strategies useful for more personalized patient care.

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Antidepressants and Fracture Risk in Older Adults: A Comparative Safety Analysis

Cited by 54 publications

References 34 publications

Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS)

Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS)

Clinician-Identified Depression in Community Settings: Concordance with Structured-Interview Diagnoses

Common Selective Serotonin Reuptake Inhibitor Side Effects in Older Adults Associated with Genetic Polymorphisms in the Serotonin Transporter and Receptors: Data from a Randomized Controlled Trial

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