A recent systematic review and meta-analysis assessed the adverse effects of antidepressant therapies among older patients (≥65 years old) with major depressive disorder (MDD).
Study authors searched Medline, Embase, Cochrane Central, PsycINFO bibliographic databases, and clinicaltrials.gov for randomized controlled trials (RCTs), prospective or retrospective cohort studies, and case-controlled studies assessing the association between antidepressant medications and overall adverse events, arrhythmias, cognitive impairment, falls, fractures, hospitalization, death, QTc prolongation, and study withdrawal.
Studies included in the review compared a variety of antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], bupropion, mirtazapine, trazodone, vilazodone, and vortioxetine) with placebo, nonpharmacologic therapy, or a different antidepressant medication.
The review included 19 RCTs and 2 observational studies, the majority of which analyzed treatment of moderate MDD during the acute phase (<12 weeks). Findings of the study revealed that the frequency of adverse events compared with placebo was statistically similar in patients receiving SSRIs (moderate strength of evidence [SOE]; relative risk [RR]: 1.07; 95% CI: 0.98, 1.16) but was higher in patients taking SNRIs (high SOE; RR: 1.14; 95% CI: 1.03, 1.25).
Additionally, the analysis revealed an increased number of study withdrawals due to adverse events in patients treated with both SSRIs (low SOE; RR: 2.90; 95% CI: 1.16, 5.06) as well as SNRIs (moderate SOE; RR: 1.85; 95% CI: 1.05, 3.27) compared with placebo. Findings also showed that patients receiving duloxetine experienced a greater number of falls during the acute and continuation phases of MDD (24 weeks) compared with placebo (moderate SOE).
“Because we evaluated some therapies on a class basis (SSRI and SNRI), evidence should not be extrapolated to specific agents within the class,” the authors noted. They concluded that comparative long-term studies assessing specific adverse events are needed in order to help clinicians choose the most appropriate antidepressant therapy for this patient population.
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