Popular Antidepressants Not Always Best Choice for
TUESDAY, Aug. 2 (HealthDay News) -- New research suggests that
hugely popular antidepressants such as Prozac and Effexor might not
always be the best choice for seniors, since they seem to have more
side effects than older antidepressants do.
Prozac (fluoxetine) and Effexor (venlafaxine) belong to the
class of drugs known as selective serotonin reuptake inhibitors
(SSRIs), and are generally considered safe and effective. But a new
British study appearing in the Aug. 2 issue of the
BMJ finds that an older group of drugs known as tricyclic
antidepressants may sometimes be safer in people over the age of
Still, several factors need to be considered when choosing an
antidepressant, possible side effects being just one of them.
"The choice of class of antidepressant is a complex decision, and some evidence is still lacking to help with that choice in older patients," said study author Carol Coupland, associate professor of medical statistics at the University of Nottingham. "Low-dose [tricyclic antidepressants] may be more suitable in frail elderly patients at increased risk of falls and fracture."
Although SSRIs (which also include Celexa, Paxil and Zoloft) are
widely prescribed for depression in seniors, few trials have
actually looked at the safety and effectiveness of these drugs in
this group of people, added Angie Hochhalter, an assistant
professor of internal medicine atTexas A&M Health Science
Center College of Medicine.
"We don't find out how the drugs actually work [for seniors] until they've been out for a while," noted Hochhalter, who is also a research scientist in geriatrics at Scott & White in Temple. She was not involved in the new research.
In the study, Coupland's team looked at prescription data on
more than 60,000 patients aged 65 to 100 who had been newly
diagnosed with depression.
Ninety percent of patients had received one or more
prescriptions for antidepressants, 55 percent of those for an SSRI
and 32 percent for a tricyclic antidepressant. The rest were on
Seniors on SSRIs had a higher risk of dying, having a stroke,
falling, breaking a bone and seizures compared with those not
taking any antidepressant.
Over the course of a year, 10.6 percent of seniors taking an
SSRI died vs. 8 percent of those taking tricyclics and 7 percent of
those taking no antidepressant at all.
More than 11 percent of those taking other antidepressants
Looking at particular antidepressants, Effexor an SSRI, and two
tetracyclic drugs, Remeron (mirtazapine) and Desyrel (trazodone),
showed the highest risks.
The researchers also noted that the risks were highest in the
month after starting an antidepressant and the month after
discontinuing the drug.
There was one important limitation to the findings -- tricyclics
tended to be prescribed at lower doses than SSRIs, which "can
explain at least some of our findings of lower risks associated
with [tricyclics]," said Coupland. She added, however, that "there
is some evidence from other studies that low-dose [tricyclics] may
be as effective as higher doses in reducing symptoms of
This study did not look at the relative effectiveness of the
drugs, nor did it look at people who had already been taking SSRIs
for years or even decades, Hochhalter pointed out.
The message here is certainly not to avoid SSRIs at all costs,
"When you find the right medication, it can be a lifesaver. But it's so complicated, seniors need to have an ongoing conversation with their doctors," Hochhalter said.
And, added Coupland, "careful monitoring is needed, particularly
during the first month of treatment, whichever class is
The U.S. National Institutes of Health has more on
depression in older adults.
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