While antidepressant drugs can be an important tool in the care of older adults with major depressive disorder, the risks associated with some of these medications may outweigh their benefits, according to a U.S. government-funded review and meta-analysis.

Up to 20% of people aged 65 and older living independently may deal with symptoms of the disorder, and that rate can rise to 50% for nursing home residents. Clinicians who treat these patients may be best served by understanding which antidepressants have been studied with respect to safety and how their safety compares with other treatment options, wrote Diana Sobieraj, Ph.D. the report’s lead author.

In studies reviewed by the researchers, a number of commonly used antidepressant drugs were found to be associated with negative consequences for patients. In particular, in patients 65 years of age or older, “treatment of the acute phase of MDD with SNRIs, but not SSRIs, was associated with a statistically greater number of overall adverse events vs. placebo,” wrote Sobieraj. In addition, SSRIs and SNRIs led to a greater number of study withdrawals due to adverse events vs. placebo, and the drug duloxetine, an SSRI, increased the risk of falls, she wrote.

“Some of the antidepressants have not been studied in older patients with major depression, and studies don’t often describe specific side effects,” Sobieraj told the American Geriatrics Society. “Future research in this field is critical to better inform how the safety profiles of different antidepressants compare in older adults,” she said.

Clinicians who wish to see which medications are best avoided for adults with specific conditions can use the AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults, a tool which was updated in 2019, the study’s authors note.

Read the review