Correspondence

Antidepressants and Falls among Nursing Home Residents

N Engl J Med 1999; 340:320January 28, 1999

Article

To the Editor:

Thapa et al. (Sept. 24 issue)1 performed an important retrospective study of the risk of falls among nursing home residents receiving antidepressants. The increased risk of falls with the use of tricyclic antidepressants is not surprising, but the increased risk of falls with the selective serotonin-reuptake inhibitors is.

The authors explain the increased rate of falls on the basis of an increased rate of depression coinciding with increased disability, and they note the hypothesis that the health of residents of long-term care facilities changes (for the worse) about the time the residents begin to receive antidepressants. The authors conclude that rates of falls may not be materially reduced by preferential use of serotonin-reuptake inhibitors rather than tricyclic antidepressants.

We suggest as an alternative interpretation, only to be proved with further study, that the group of patients receiving tricyclic antidepressants may not have received sufficiently high doses for their depression (doses were generally low, and outcome measures of depression were not reported) and were at risk for falls only because of the side effects of the tricyclic antidepressants. The group of patients receiving selective serotonin-reuptake inhibitors, though receiving more appropriate doses, had a paradoxically increased rate of falls because of the resolution of their depression and an increase in their activities, which put them at increased risk for falls.

James R. Slaughter, M.D.
David A. Beck, M.D.
Annette McDonald, R.N.-C.S., M.S.
University of Missouri–Columbia, Columbia, MO 65212

1 References

1. 1

   Thapa PB, Gideon P, Cost TW, Milam AB, Ray WA. Antidepressants and the risk of falls among nursing home residents. N Engl J Med 1998;339:875-882
   Full Text | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: We appreciate the thoughtful comments of Dr. Slaughter and colleagues and concur that more prospective research is needed to elucidate the appropriateness and consequences of antidepressant therapy for residents of nursing homes. The hypothesis that the increased rate of falls during antidepressant therapy is related to increased activity as the depression resolves is interesting. However, this hypothesis suggests that the rate of falls would increase gradually throughout therapy, paralleling the well-known curve for improvement of symptoms. This is not consistent with our finding (shown in Figure 1 in our article) that the rate of falls was increased for all types of antidepressants a mean of 15 days after the initiation of therapy and did not increase subsequently.

Wayne A. Ray, Ph.D.
Vanderbilt University School of Medicine, Nashville, TN 37232-2637

Purushottam B. Thapa, M.B., B.S., M.P.H.
University of Arkansas for Medical Sciences, Little Rock, AR 72205

Citing Articles (1)

Citing Articles

1. 1

   Meridean L. Maas, Janet P. Specht, Kathleen C. Buckwalter, Josephine Gittler, Kate Bechen. (2008) Nursing Home Staffing and Training Recommendations for Promoting Older Adults’ Quality of Care and Life. Research in Gerontological Nursing 1:2, 123-133
   CrossRef