New antidepressants can increase risks for elderly, study suggests

ScienceDaily (Aug. 3, 2011) — Older people taking new generation antidepressants are at more risk of dying or suffering from a range of serious health conditions including stroke, falls, fractures and epilepsy, suggests a new study involving researchers at The University of Nottingham.

The research, published on the British Medical Journal website, discovered that selective serotonin reuptake inhibitors (SSRIs) are more strongly associated with an increased risk of several adverse outcomes in people over the age of 65 with depression compared with older tricyclic antidepressants (TCAs).

The authors say the risks and benefits of different antidepressants should be carefully considered when prescribing these drugs to elderly patients and have called for further research to investigate the findings.

Dr Carol Coupland, Associate Professor in Medical Statistics in The University of Nottingham's Division of Primary Care said: "We've found some evidence from our study that the older tricyclic antidepressants may be associated with lower risks of several adverse outcomes compared with newer antidepressants in older people diagnosed as having depression.

"This was an unexpected finding, and so further research using other data sources is needed to confirm these findings as well as provide more evidence on the benefits of different antidepressants in this group of people."

Depression is a common condition in older people and antidepressants -- particularly SSRIs -- are widely used. However, very little is known about the safety of these drugs in older people.

The team of researchers from the Universities of Nottingham and East Anglia set out to investigate the potential link between antidepressant treatment and the risk of a number of potentially life-threatening outcomes in older people.

They identified 60,746 UK patients aged 65 and over with a newly diagnosed episode of depression between 1996 and 2007 using the QResearch primary care database. Many patients had other conditions, such as heart disease and diabetes, and were taking several medications.

Patients were tracked until the end of 2008. During this time, 89 per cent (54,038) received at least one prescription for an antidepressant, and a total of 1,398,359 prescriptions for antidepressants were received. Of these 57 per cent were for SSRIs, 31 per cent for TCAs, 0.2 per cent for monoamine oxidase inhibitors (MAOIs) and 13.5 per cent for other antidepressants.

Antidepressant use was then analysed against several adverse outcomes including all-cause mortality, attempted suicide or self harm, heart attack, stroke, falls, fractures, epilepsy or seizures and high salt levels in the blood (hyponatraemia).

After adjusting for factors that could affect the results, including age, sex, severity of depression, other illnesses and use of other medications, the team found that SSRIs and drugs in the group of other antidepressants were associated with an increased risk of several adverse outcomes compared with TCAs.

Those taking SSRIs were more likely to die, suffer a stroke, fall or fracture, have epilepsy or a seizure and have hyponatraemia compared with TCAs. The group of other antidepressants were associated with an increased risk of mortality, attempted suicide or self-harm, stroke, fracture and epilepsy or seizures.

Patients in the study had a seven per cent risk of dying over one year while they were not taking antidepressants, while the comparable risks were 8.1 per cent when taking TCAs, 10.6 per cent for SSRIs and 11.4 per cent for the group of other antidepressants. For stroke, one-year risks were 2.3 per cent, 2.6 per cent and three per cent (compared with 2.2 per cent when not on antidepressants) and for fracture they were 2.2 per cent, 2.7 per cent and 2.8 per cent compared with 1.8 per cent.

Among individual drugs trazodone, mirtazapine and venlafaxine carried the highest risk for some adverse outcomes.

Rates of most adverse outcomes were highest in the 28 days after starting the antidepressant and also in the 28 days after stopping.

The authors also point out that TCAs were prescribed at lower doses than SSRIs and other antidepressant drugs, which they say "could in part explain our findings." They also caution that differences between patients prescribed different antidepressant drugs may account for some of the associations seen in the study, underlining the need for further research to confirm the findings.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Nottingham, via AlphaGalileo.

Journal Reference:

C. Coupland, P. Dhiman, R. Morriss, A. Arthur, G. Barton, J. Hippisley-Cox. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ, 2011; 343 (aug02 1): d4551 DOI: 10.1136/bmj.d4551

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Who takes risks?

ScienceDaily (July 27, 2011) — It's a common belief that women take fewer risks than men, and that adolescents always plunge in headlong without considering the consequences. But the reality of who takes risks when is actually a bit more complicated, according to the authors of a new paper which will be published in the August issue of Current Directions in Psychological Science, a journal of the Association for Psychological Science. Adolescents can be as cool-headed as anyone, and in some realms, women take more risks than men.

A lot of what psychologists know about risk-taking comes from lab studies where people are asked to choose between a guaranteed amount of money or a gamble for a larger amount. But that kind of decision isn't the same as deciding whether you're going to speed on the way home from work, wear a condom, or go bungee jumping. Research in the last 10 years or so has found that the way people choose to take risks in one domain doesn't necessarily hold in other domains.

"The typical view is that women take less risks than men, that it starts early in childhood, in all cultures, and so on," says Bernd Figner of Columbia University and the University of Amsterdam, who cowrote the paper with Elke Weber of Columbia University. The truth is more complicated. Men are willing to take more risks in finances. But women take more social risks -- a category that includes things like starting a new career in your mid-thirties or speaking your mind about an unpopular issue in a meeting at work.

It seems that this difference is because men and women perceive risks differently. That difference in perception may be partly because of how familiar they are with different situations, Figner says. "If you have more experience with a risky situation, you may perceive it as less risky." Differences in how boys and girls encounter the world as they're growing up may make them more comfortable with different kinds of risks.

Adolescents are known for risky behavior. But in lab tests, when they're called on to think coolly about a situation, psychological scientists have found that adolescents are just as cautious as adults and children. The difference between the lab and the real world, Figner says, is partly the extent to which they involve emotion. In an experiment where adolescents' emotions got triggered strongly (with a gambling task in which they made stepwise decisions of increasing risk and got immediate feedback on how good or bad they were doing, a situation much closer to real-world incremental or dynamic risk decisions), they looked very different from children and adults and took bigger risks, just as observed in real world settings.

Emotion can affect decisions about risk-taking in all age groups, not just adolescents, Figner says. And the emotion doesn't necessarily have to be triggered from the decision situation itself even, for example. if you're angry about an argument, you might later drive too fast on the highway.

"Ultimately we would like to provide knowledge with our research that people can use to make decisions that are more beneficial for them in the long term," Figner says. The goal isn't to avoid risk, of course -- stepping out the front door in the morning increases your chance of getting run over by a bus. But by understanding when and how people decide to take risks, he hopes to help people make risky decisions that they won't regret, either immediately after they have made them, or years later.

The title of the article is, "Who Takes Risks When and Why? Determinants of Risk-Taking."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Association for Psychological Science.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here