Risk factors for falls during treatment of late-life depression.
BACKGROUND
Prior studies have found that antidepressant medications are associated with an increased risk of falling in elderly persons. However, little is known about the prevention of falls during treatment for depression in elderly persons. This study evaluated the time course and potential risk factors for falls in a treatment protocol for late-life depression to identify specific at-risk periods and risk factors for falls in this population.


METHODS
One hundred four subjects aged 69 years and over were treated in a protocolized manner using paroxetine and interpersonal psychotherapy. Those who did not respond received augmentation therapy with bupropion, nortriptyline, or lithium. Subjects were assessed at baseline and weekly during treatment; demographic and clinical characteristics of those who experienced a fall during treatment were compared with those who did not fall. Cox proportional hazards models were used to define risk factors for falls in univariate and multivariate models.


RESULTS
During a mean of 21 weeks of treatment, 40 subjects (38%) fell. About half (53%) of the subjects fell during the first 6 weeks of treatment. In the multivariate model, memory impairment and orthostatic changes in blood pressure during treatment were risk factors for falling. Additionally, augmentation with bupropion appeared to be a risk factor for falls in univariate analysis, but this result is preliminary due to the small number of subjects who took bupropion.


CONCLUSIONS
Increased monitoring for falls is warranted during the acute treatment of late-life depression. When treating such patients, clinicians should be especially watchful of those with memory impairments or those who develop orthostatic blood pressure changes; orthostatic blood pressure should be measured throughout acute treatment. Additionally, augmenting paroxetine with bupropion may also increase the risk of falls, and this medication combination should be used with caution in elderly patients.
Joo
Jin H
JH
Intervention Research Center for Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA.
Lenze
Eric J
EJ
Mulsant
Benoit H
BH
Begley
Amy E
AE
Weber
Elizabeth M
EM
Stack
Jacqueline A
JA
Mazumdar
Sati
S
Reynolds
Charles F
CF
Pollock
Bruce G
BG
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D016642:Bupropion / Q000009:adverse effects / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy* / Q000628:therapy; D004359:Drug Therapy, Combination; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced / Q000175:diagnosis; D008297:Male; D015999:Multivariate Analysis; D017374:Paroxetine / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D016019:Survival Analysis
D000928:Antidepressive Agents; D016642:Bupropion; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors