Older adults taking serotonin norepinephrine reuptake inhibitors (SNRIs) experienced more adverse events, compared with placebo, according to a systematic review and meta-analysis published online in the Journal of the American Geriatrics Society.
The frequency of adverse events with selective serotonin reuptake inhibitors (SSRIs), meanwhile, did not differ from placebo in the population.
Researchers assessed adverse events of antidepressants in older adults with major depressive disorder. The investigation included 19 randomized controlled trials and 2 observational studies that spanned outpatient, rehabilitation, and nursing facility settings.
“The prevalence of depression in community‐based adults 65 years of age and older is 15% to 20% in the United States, although estimations are subject to bias; depression prevalence of more than 50% in older nursing home residents was reported,” researchers wrote. “In addition to the modest efficacy provided by antidepressant medications, clinicians must consider the safety risks associated with the treatments.”
The investigation identified a higher number of overall adverse events with SNRIs, compared with placebo, during the acute treatment stage, and similar numbers of adverse events with SSRIs and placebo. Both SNRIs and SSRIs were linked with more study withdrawals due to adverse events compared with placebo, researchers found, although specific details on adverse events were sparse.
The analysis also revealed the SSRI duloxetine was associated with more falls, compared with placebo, during 24 weeks of acute and continuation treatment. Because only single randomized controlled trials were available for analysis, researchers were limited in their ability to analyze differences in adverse events for bupropion, mirtazapine, trazadone, and vortioxetine.
“Some of the antidepressants have not been studied in older patients with major depression, and studies don’t often describe specific side effects,” said study co-author Diana M. Sobieraj, PharmD, FCCP, BCPS, an assistant professor at University of Connecticut, Storrs, where the systematic review was performed.
“Future research in this field is critical to better inform how the safety profiles of different antidepressants compare in older adults.”
Sobieraj DM, Martinez BK, Hernandez AV, et al. Adverse effects of pharmacologic treatments of major depression in older adults. Journal of the American Geriatrics Society. 2019 May 29;[Epub ahead of print].