Also of interest, is that the drug is not shown to be anymore effective for managing depression at doses greater than 40mg per day.

The link to the FDA alert is:

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm269481.htm

The newer class of antidepressants, which includes Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Paxil (paroxetine), Lexapro (escitalopram), called SSRIs, or selective serotonin reuptake inhibitors, was associated with higher levels of risk in many areas. One or more of the drugs in this class were associated with a higher risk of falls and low serum sodium (hyponatremia) which can be serious and warranting hospitalization. Other studies have confirmed these higher levels of risk.  The levels of risk varied and in some ares were modest increases in risk. What can be taken away from this study is that we can not assume that SSRIs are “cleaner acting” than older antidepressants and that they carry their own level of risk for adverse outcomes. Since non-drug interventions for the treatment of depression can be equally effective as drugs, consideration should be made for those who are older and have significant risk for falls or GI bleeding, and consider non-drug treatments, also closely monitoring for adverse effects to reduce the risk for significant adverse outcomes. Other considerations in older adults would be starting with low doses and titrating up slowly, and selecting the antidepreassant that has the best side-effect profile. Other drugs in the study that were associated with significant adverse effects were trazodone, Effexor (venlafaxine), and Remeron (mirtazapine).

The authors list several limitations to their observational study and suggest further research in this area should be done to confirm their findings. Also of interest is that several other studies have linked SSRIs with a higher increase in risk for GI bleeding. This study concluded the opposite, that SSRIs are not associated with an increased risk for GI bleeding.The authors do state that the limitations of possible selection bias and adjusting for multiple confounding variables may explain their findings. In other words, perhaps the conclusions are not quite right.

Here’s a link to the abstract of that study.

http://www.bmj.com/content/343/bmj.d4551

Neurology has also published studies that focus on reducing the risk of developing Alzheimer’s disease by treating diabetes. Researchers refer to diabetes in this subset of the population as Type 3 diabetes where it is strongly linked with “neuroaging”, a premature aging of the brain due to the metabolic and cardiovascular effects of diabetes. Also some time ago I read an Italian study that showed how nursing home admissions for Alzheimer’s disease were greatly reduced in those with hypertension when treated with an antihypertensive drug ramipril. What this says is that cardiovascular damage from these conditions is strongly linked to the development of dementia. It also suggests that if we can identify these risks then we can intervene with established treatments to slow the progression to full-blown dementia thereby aging in place.

Theories abound but what’s important is to understand the role of these risk factors and their potential for leading to dementia if left untreated. My observation in a large older adult cohort is that isolated systolic hypertension is rampant in as many at 33% of this population yet remains untreated. When you get screened for these risk factors, the next step would be to choose appropriate treatment and monitor that treatment in order to prevent adverse events from occurring. Please feel free to scan my previous posts on diabetes and neuroaging, isolated systolic hypertension and others on dementia.