title: Non-tricyclic and Non-selective Serotonin Reuptake Inhibitor Antidepressants and Recurrent Falls in Frail Older Women.
abstract: To determine the risk of recurrent falls associated with antidepressants other than tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRIs) among frail older women.
  
  
  
  This is a secondary analysis of the Zoledronic acid in frail Elders to STrengthen bone, or ZEST, trial data treated as a longitudinal cohort in 181 frail, osteoporotic women aged ≥65 years in long-term care. The primary exposure was individual non-TCA/non-SSRI antidepressants (i.e., serotonin norepinephrine reuptake inhibitors, mirtazapine, trazodone, and bupropion) at baseline and 6 months. The main outcome was recurrent (at least two) falls within 6 months after antidepressant exposure. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were derived using a generalized estimating equations model.
  
  
  
  At least 15% of women experienced recurrent falls between 0-6 and 6-12 months. At baseline and 6 months, 18.2% and 6.9% had a non-TCA/non-SSRI antidepressant, respectively. Adjusting for demographics, health status, and other drugs that increase risk of falls, non-TCA/non-SSRI antidepressant exposure significantly increased the risk of recurrent falls (AOR: 2.14; 95% CI: 1.01-4.54). Fall risk further increased after removing bupropion from the non-TCA/non-SSRI antidepressant group in sensitivity analyses (AOR: 2.73; 95% CI: 1.24-6.01).
  
  
  
  Other antidepressant classes may not be safer than TCAs/SSRIs with respect to recurrent falls in frail older women.
authors.affiliation: Department of Medicine, Division of Geriatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Naples
authors.affiliation: Department of Medicine, Division of Geriatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Kotlarczyk
authors.affiliation: Department of Medicine, Division of Geriatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.affiliation: Department of Medicine, Division of Geriatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Greenspan
authors.affiliation: Department of Medicine, Division of Geriatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA; Center for Health Equity Research and Promotion, Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA. Electronic address: jth14@pitt.edu.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects*; D016642:Bupropion / Q000009:adverse effects; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives; D000078785:Mirtazapine; D012008:Recurrence; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D014196:Trazodone / Q000009:adverse effects*
chemical_list: D000928:Antidepressive Agents; D016642:Bupropion; D008803:Mianserin; D000078785:Mirtazapine; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone
keywords: antidepressants; frailty; long-term care; older adults; recurrent falls