title: Effect of sertraline on risk of falling in older adults with psychotic depression on olanzapine: results of a randomized placebo-controlled trial.
abstract: OBJECTIVE
  Observational studies report that selective serotonin reuptake inhibitor (SSRI) antidepressants are associated with an increased risk of falls in the elderly, but these studies may overestimate drug-specific risk because of confounding. A randomized controlled trial (RCT) is the optimal way to assess the causal relationship between use of an SSRI and falls. We therefore analyzed data from a RCT of the treatment of psychotic depression, to examine whether combined olanzapine and sertraline interacted with older age to increase the risk of falling compared with olanzapine plus placebo.
  
  
  METHODS
  Double-blind placebo-controlled RCT.
  
  
  METHODS
  Four academic medical centers.
  
  
  METHODS
  Two hundred fifty-nine patients with major depressive disorder with psychotic features (N = 117 aged 18-59 years and N = 142 aged 60 years or older).
  
  
  METHODS
  Twelve weeks of randomized double-blind treatment with olanzapine plus sertraline or olanzapine plus placebo.
  
  
  METHODS
  Proportion of participants who fell at least once.
  
  
  RESULTS
  Older participants were significantly more likely than younger participants to fall. Among older participants, the odds ratio of falling with olanzapine plus sertraline versus olanzapine plus placebo was 1.56 (95% confidence interval: 0.63-3.83). There was not a statistically significant treatment effect or treatment × age interaction with respect to the proportion of participants falling. These negative results may have been due to low statistical power.
  
  
  CONCLUSIONS
  Evaluating the association between SSRIs and falls in a RCT is limited by the large sample size that is required. An alternative approach is to examine the effect of an SSRI on measures of postural stability and gait that are valid markers of risk of falling.
authors: Department of Psychiatry, University of Toronto, Canada; Department of Psychiatry, University Health Network, Toronto, Canada; Toronto General and Toronto Rehab Research Institutes, Toronto, Canada. Electronic address: alastair.flint@uhn.on.ca.
authors: Alastair J
authors: AJ
authors: Flint
authors: Department of Psychiatry, University of Toronto, Canada; Department of Psychiatry, University Health Network, Toronto, Canada.
authors: Andrea
authors: A
authors: Iaboni
authors: Department of Psychiatry, University of Toronto, Canada; Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; Centre for Addiction and Mental Health, Toronto, Canada.
authors: Benoit H
authors: BH
authors: Mulsant
authors: University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA.
authors: Anthony J
authors: AJ
authors: Rothschild
authors: Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Ellen M
authors: EM
authors: Whyte
authors: Department of Psychiatry, Weill Medical College of Cornell University and New York Presbyterian Hospital-Westchester Division, NY.
authors: Barnett S
authors: BS
authors: Meyers
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D020280:Sertraline / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine; D020280:Sertraline
keywords: Selective serotonin reuptake inhibitor; aged; depression; falls; randomized controlled trial
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