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Depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review

PURPOSE: The aim of this clinical review was to summarize the existing knowledge on fall risk associated with antidepressant use in older adults, describe underlying mechanisms, and assist clinicians in decision-making with regard to (de-) prescribing antidepressants in older persons. METHODOLOGY: W...

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Autores principales: van Poelgeest, E. P., Pronk, A. C., Rhebergen, D., van der Velde, N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149338/
https://www.ncbi.nlm.nih.gov/pubmed/33721264
http://dx.doi.org/10.1007/s41999-021-00475-7
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author van Poelgeest, E. P.
Pronk, A. C.
Rhebergen, D.
van der Velde, N.
author_facet van Poelgeest, E. P.
Pronk, A. C.
Rhebergen, D.
van der Velde, N.
author_sort van Poelgeest, E. P.
collection PubMed
description PURPOSE: The aim of this clinical review was to summarize the existing knowledge on fall risk associated with antidepressant use in older adults, describe underlying mechanisms, and assist clinicians in decision-making with regard to (de-) prescribing antidepressants in older persons. METHODOLOGY: We comprehensively examined the literature based on a literature search in Pubmed and Google Scholar, and identified additional relevant articles from reference lists, with an emphasis on the most commonly prescribed drugs in depression in geriatric patients. We discuss use of antidepressants, potential fall-related side effects, and deprescribing of antidepressants in older persons. RESULTS: Untreated depression and antidepressant use both contribute to fall risk. Antidepressants are equally effective, but differ in fall-related side effect profile. They contribute to (or cause) falling through orthostatic hypotension, sedation/impaired attention, hyponatremia, movement disorder and cardiac toxicity. Falling is an important driver of morbidity and mortality and, therefore, requires prevention. If clinical condition allows, withdrawal of antidepressants is recommended in fall-prone elderly persons. An important barrier is reluctance of prescribers to deprescribe antidepressants resulting from fear of withdrawal symptoms or disease relapse/recurrence, and the level of complexity of deprescribing antidepressants in older persons with multiple comorbidities and medications. Practical resources and algorithms are available that guide and assist clinicians in deprescribing antidepressants. CONCLUSIONS: (De-) prescribing antidepressants in fall-prone older adults is often challenging, but detailed insight in fall-related side effect profile of the different antidepressants and a recently developed expert-based decision aid STOPPFalls assists prescribers in clinical decision-making.
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spelling pubmed-81493382021-06-01 Depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review van Poelgeest, E. P. Pronk, A. C. Rhebergen, D. van der Velde, N. Eur Geriatr Med Review PURPOSE: The aim of this clinical review was to summarize the existing knowledge on fall risk associated with antidepressant use in older adults, describe underlying mechanisms, and assist clinicians in decision-making with regard to (de-) prescribing antidepressants in older persons. METHODOLOGY: We comprehensively examined the literature based on a literature search in Pubmed and Google Scholar, and identified additional relevant articles from reference lists, with an emphasis on the most commonly prescribed drugs in depression in geriatric patients. We discuss use of antidepressants, potential fall-related side effects, and deprescribing of antidepressants in older persons. RESULTS: Untreated depression and antidepressant use both contribute to fall risk. Antidepressants are equally effective, but differ in fall-related side effect profile. They contribute to (or cause) falling through orthostatic hypotension, sedation/impaired attention, hyponatremia, movement disorder and cardiac toxicity. Falling is an important driver of morbidity and mortality and, therefore, requires prevention. If clinical condition allows, withdrawal of antidepressants is recommended in fall-prone elderly persons. An important barrier is reluctance of prescribers to deprescribe antidepressants resulting from fear of withdrawal symptoms or disease relapse/recurrence, and the level of complexity of deprescribing antidepressants in older persons with multiple comorbidities and medications. Practical resources and algorithms are available that guide and assist clinicians in deprescribing antidepressants. CONCLUSIONS: (De-) prescribing antidepressants in fall-prone older adults is often challenging, but detailed insight in fall-related side effect profile of the different antidepressants and a recently developed expert-based decision aid STOPPFalls assists prescribers in clinical decision-making. Springer International Publishing 2021-03-15 2021 /pmc/articles/PMC8149338/ /pubmed/33721264 http://dx.doi.org/10.1007/s41999-021-00475-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review
van Poelgeest, E. P.
Pronk, A. C.
Rhebergen, D.
van der Velde, N.
Depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review
title Depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review
title_full Depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review
title_fullStr Depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review
title_full_unstemmed Depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review
title_short Depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review
title_sort depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149338/
https://www.ncbi.nlm.nih.gov/pubmed/33721264
http://dx.doi.org/10.1007/s41999-021-00475-7
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