Warnings loom over antidepressant use

Australian Medical Association president, Dr Steve Hamilton, supports a recent British study which reveals people aged over 65 years of age, who take new generation antidepressants may suffer serious health conditions or even premature death.

Dr Hamilton told DPS eNews the British findings, which allegedly revealed selective serotonin reuptake inhibitor (SSRIs) are more strongly associated with an increased risk of several adverse outcomes in depressed people aged over 65 years compared with older tricyclic antidepressants (TCAs), are credible.

“TCAs are more traditional and have been around for years. SSRIs (another type of antidepressant) have been known to increase confusion in elderly people and works as a bit of a sedative,” Dr Hamilton says.

The British research reveals people aged 65 years or older, who take new generation antidepressants, may suffer from serious health conditions such as stroke, falls, fractures and epilepsy or could be at a greater risk of premature death.

The authors of the study, who have called for further research into investigating the findings, say the risks and benefits of different antidepressants should be carefully considered when prescribing these drugs to patients in this age group.

The team of researchers from the Universities of Nottingham and East Anglia set out to investigate the potential link between antidepressant treatments and the risk of a number of potentially life-threatening outcomes in people from this age group.

Using a primary care database, researchers identified 60,746 UK patients aged 65 years of age and over with a newly diagnosed episode of depression between 1996 and 2007. Many patients had other conditions, such as heart disease and diabetes, and were taking several medications.

During the period that the study was conducted, 89% of the patients received at least one prescription for an antidepressant, with a total of 1,398,359 prescriptions for antidepressants received. Of these, 57% were for SSRIs, 31% for TCAs, and 13.5% for other antidepressants.

After adjusting factors that could affect the results; including age, sex, severity of depression, other illnesses and use of other medications, the team found SSRIs and drugs in the group of other antidepressants were associated with an increased risk of several adverse outcomes compared with TCAs.

Those taking SSRIs were more likely to suffer a stroke, fall or fracture, have epilepsy or a seizure, or die compared with users of TCAs.

Dr Hamilton says it is important for GPs to think carefully about dosages and the type of antidepressant given to an older patient.

“Medical practitioners need to determine what the best treatment is and should be careful when prescribing drugs that may interfere or have an effect on other medications the patient may be taking,” he says.

Natural herbal supplements and some painkillers are drugs which Dr Hamilton says may have an adverse effect on certain antidepressants.

However, Dr Hamilton claims, ultimately, antidepressant treatment for some people aged over the age of 65 needs to be “tailored to the individual” and dependent on their past medical history.

“Most elderly people do not have one condition; they have three or four, and GPs need to monitor how antidepressants will react, and how they will interact, to other drugs which may be taken for these various pre-existing conditions,” he says.

“At the end of the day, it is best to see your family doctor as they will likely be the person to understand your condition the most,” Dr Hamilton says.