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First-line antidepressants were associated with a decreased risk of falls and related injuries among older adults, according to a cohort study.

Of more than 100,000 Medicare beneficiaries newly diagnosed with depression, use of first-line antidepressants was associated with a decreased risk of falls and related injuries compared with no treatment, with adjusted hazard ratios ranging from 0.74 (95% CI 0.59-0.89) for bupropion (Wellbutrin) to 0.83 (95% CI 0.67-0.98) for escitalopram (Lexapro), reported Wei-Hsuan Lo-Ciganic, PhD, MSPharm, of the University of Pittsburgh, and co-authors.

The event rates for falls and related injuries were also lower for patients treated with bupropion compared with those who did not receive treatment (63 vs 87 per 1,000 person-years), with event rates for all other antidepressants falling between those rates, they noted in .

The restricted mean survival time, which represents the area under the survival curve up to a specific time point and can be interpreted as the mean time before the event or censoring points, ranged from 349 days (95% CI 346-350) for those who were untreated to 353 days (95% CI 350-356) for those treated with bupropion.

The authors also noted that psychotherapy was not associated with risk of falls and related injuries compared with no treatment (adjusted HR 0.94, 95% CI 0.82-1.17), with an event rate of 82 per 1,000 person-years.

"Over half of older adults with depression did not receive psychotherapy or first-line antidepressants within the first 90 days after their diagnosis," Lo-Ciganic told MedPage Today. "There have been concerns that the side effects of some antidepressants, such as drowsiness, balance problems, and changes in blood pressure, could increase the risk of falls and related injuries in older adults."

In fact, she explained that recommended against using antidepressants in this patient population for fear of exacerbating those issues.

"However, this recommendation might not be practical, given the importance of treating depressive symptoms," Lo-Ciganic added. "Our study provides important safety information for clinicians to consider when choosing different first-line antidepressant treatments for older adults."

She noted that previous studies that suggested an increased risk of falls and injuries with antidepressants did not compare outcomes with all commonly used first-line antidepressants. They also did not account for depression as an underlying cause of a patient's falls, rather than the antidepressant medication.

For this study, the authors used 2016-2019 Medicare claims data on 101,953 eligible Medicare beneficiaries ages 65 and older with newly diagnosed depression. Mean age was 76 years, 62.1% were women, 80.3% were white, and 7.3% were Black.

They used a target trial emulation framework with a cloning-censoring-weighting approach to analyze the data. Rates of falls and related injuries were based on events recorded within 1 year of a participant's diagnosis using the .

Among the beneficiaries, 45.2% did not receive any treatment, and 14.6% received psychotherapy. The most common first-line antidepressants included sertraline (Zoloft; 9.2%), escitalopram (9%), citalopram (Celexa; 4.7%), mirtazapine (Remeron; 3.8%), duloxetine (Cymbalta; 3.1%), trazodone (2.9%), fluoxetine (Prozac; 2.8%), bupropion (2.3%), paroxetine (Paxil; 1.4%), and venlafaxine (Effexor XR; 1%).

Lo-Ciganic pointed out that this study had several limitations, including challenges with collecting data on falls and injuries that did not receive medical attention, which may have led to an underestimate of cases. Also, the authors did not account for unmeasured factors, like lifestyle and environment.

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