A new study released by the British Journal of Clinical Pharmacology has found a significant relationship between anti-depressant use and injurious falls for nursing home residents with dementia. The authors tracked 248 ambulatory residents with dementia for two years. They found that even low doses of “SSRI” anti-depressants (common SSRIs include Prozac, Paxil, Zoloft, Celexa, and Lexapro), appreciably increased residents’ fall risks. At one-quarter of the average daily dose, fall risk increased 31%. At one-half average dosage, the risk increased 73% and at the full average dose, the risk increased 198%. The weakness of the study is the authors were not able to determine if the increased fall risk comes from the drugs or from the underlying depression or both.
This study further erodes the notions that anti-depressant misuse in nursing homes is somehow less egregious than anti-psychotic misuse or that anti-depressants are a good first treatment for residents who are sad. As is the case with anti-psychotics, drug options should only be used as a last resort after non-pharmacological options have been tried and failed. Sadness in nursing homes or as a result of dementia seems like a very natural response to difficult and frustrating life changes. Myriad non-pharm options exist to ease transitions and lift spirits, which in turn likely decrease fall risks.