A comparative analysis of selective serotonin reuptake inhibitors and fall risk in older adults

Abstract

Background: One in five older adults (age 65+) uses an antidepressant medication. However, little is known about how fall risk differs between commonly prescribed medications. We examine the comparative association between individual selective serotonin reuptake inhibitors (SSRI) and self-reported falls in older adults.

Methods: We used data from 2010-2017 Medicare Current Beneficiary Surveys, a nationally representative survey of Medicare beneficiaries. We included participants from three different panels surveyed over two successive years. Participants were limited to community-dwelling Medicare beneficiaries 65+, enrolled in Medicare Part D, and taking an SSRI (n = 1023) during baseline years. Participants were asked about demographic and health characteristics, medication use (including dose, frequency, duration of use) and self-reported falls as any fall or recurrent falls in the past year. We compared individual SSRI (citalopram or escitalopram vs sertraline) use by the average monthly total standardized daily dose (TSDD) and self-reported falling, controlling for potential confounders. Descriptive analysis and multivariable logistic regressions were conducted using SAS-callable SUDAAN.

Results: Citalopram/escitalopram (n = 460 users; 45.0% of all SSRI users) and sertraline (n = 294 users; 28.7% of all SSRI users) were the most commonly prescribed SSRIs. Overall, 36.3% of citalopram/escitalopram users and 39.4% of sertraline users reported a fall in the year following medication use. There were no statistically significant differences between sertraline and citalopram/escitalopram users of either low or medium TSDD levels in the risk of self-reported any or recurrent falls. However, users of high TSDD of sertraline (>75 mg) had a lower risk of recurrent falls compared to high TSDD citalopram (>30 mg) or escitalopram (>15 mg) daily for 30 days.

Conclusion: These findings suggest a potential comparative safety benefit of sertraline compared to citalopram/escitalopram at high doses related to recurrent falls. Additional comparative studies of individual antidepressants may better inform fall risk management and prescribing for older adults.

Keywords: SSRIs; antidepressants; falls; older adults.

Figure 1:

Crude and adjusted risk ratios of average monthly total standardized daily dose of selective serotonin reuptake inhibitors and recurrent falls – Medicare Current Beneficiary Surveys, 2010 −2017 ¹Risk ratios are adjusted for demographic characteristics (age, sex, race), and health characteristics (self-reported health status, fall history, health conditions limited to diabetes, depression, stroke), and concurrent psychoactive medication use as mean number of medications during medication exposure window. ²CI = 95% confidence interval ³TSDD = Average monthly total standardized daily dose categorized into low (60 or less), medium (60.1–90), and high (more than 90). For citalopram: Low TSDD is equivalent to ≤20 mg daily for 30 days; Medium TSDD is equivalent to >20 mg to 30 mg daily for 30 days; High TSDD is equivalent to >30 mg daily for 30 days. For escitalopram: Low TSDD is equivalent to ≤10 mg daily for 30 days; Medium TSDD is equivalent to >10 mg to 15 mg daily for 30 days; High TSDD is equivalent to >15 mg daily for 30 days. For Sertraline: Low TSDD is equivalent to ≤50 mg daily for 30 days; Medium TSDD is equivalent to >50 mg to 75 mg daily for 30 days; High TSDD is equivalent to >75 mg daily for 30 days.