2025/01/17 by Cini Bhanu, Kate Walters, Mine Orlu +3 · 1 voice
Health Professions · Medicine · #Balance, Gait, and Falls Prevention #Cardiovascular Syncope and Autonomic Disorders #Intraoperative Neuromonitoring and Anesthetic Effects
paper · pdf · doi:10.3399/bjgp.2024.0429
openalex publication_date 2025/01/17 · openalex created_date 2025/01/18 · openalex updated_date 2026/07/28
BACKGROUND: Antidepressants are associated with postural hypotension (PH), but it is not typically recognised as a common adverse effect. PH is linked with serious complications in older adults, for example, falls, stroke, and cognitive decline. Randomised controlled trials (RCTs) examining antidepressants often exclude older people and do not focus on adverse effects. AIM: To examine the risk of PH associated with antidepressant use in adults aged ≥60 years in UK primary care. DESIGN AND SETTING: A self-controlled case series using routinely collected primary care data from the IQVIA Medical Research Database (IMRD) from 1 January 2000 to 31 December 2018. METHOD: Data from >41 000 adults aged ≥60 years in IMRD between 1 January 2000 to 31 December 2018 were obtained. Antidepressant prescriptions were determined using code lists based on British National Formulary classification. Risk of PH was examined during four exposure risk periods (90-days pre-prescription; day 1-28; 29-56; and ≥57) compared with periods outside these risk windows. RESULTS: antidepressant exposure, which reduced thereafter. Risk of PH was highest with SSRIs (incidence rate ratio [IRR] 4.22, 95% confidence interval [CI] = 3.76 to 4.74), followed by 'other antidepressants' (IRR 2.17, 95% CI = 1.76 to 2.68), and then TCAs (IRR 2.12, 95% CI = 1.79 to 2.50). Risk of PH reduced from day ≥28 for all antidepressants. CONCLUSION: A statistically substantial increased risk of PH was observed with all antidepressants in the first month, particularly SSRIs. Prescribers should be aware of this risk and may consider monitoring PH when initiating antidepressants in older adults.