Drugs & Aging

, Volume 26, Issue 5, pp 381–394 | Cite as

Antidepressants and Falls in the Elderly

  • Adam DarowskiEmail author
  • Sally-Ann C. F. Chambers
  • David J. Chambers
Review Article


Antidepressants have long been recognized as a contributory factor to falls and many studies show an association between antidepressants and falls. There are extensive data for tricyclic antidepressants (TCAs) and related drugs, and for selective serotonin reuptake inhibitors (SSRIs), but few data for other classes of antidepressants.

Sedation, insomnia and impaired sleep, nocturia, impaired postural reflexes and increased reaction times, orthostatic hypotension, cardiac rhythm and conduction disorders, and movement disorders have all been postulated as contributing factors to falls in patients taking antidepressants.

Sleep disturbance is a cardinal feature of depression, and all antidepressants have effects on sleep. TCAs and related drugs cause marked sedation with daytime drowsiness. SSRIs and related drugs have an alerting effect, impairing sleep duration and quality and causing insomnia, which may result in nocturia and daytime drowsiness. Daytime drowsiness is a significant risk factor for falls, both in untreated depression and in depression treated with antidepressants.

Clinically significant orthostatic hypotension is common with TCAs and related drugs, the older monoamine oxidase inhibitors and serotonin-norepinephrine reuptake inhibitors (SNRIs). It occurs less commonly with SSRIs, and rarely with moclobemide and bupropion, and is not reported as a significant adverse effect of hypericum (St John’s wort).

Cardiac rhythm and conduction disturbances are well recognized with TCAs, tetracyclics and SNRIs, but have also been reported with SSRIs. The contribution of antidepressant-induced conduction and rhythm disturbances to falls cannot be assessed with current data.

There are insufficient data to exonerate any individual antidepressant or class of antidepressants as a potential cause of falls. The magnitude of the increased risk of falling with an antidepressant is about the same as the excess risk found in patients with untreated depression.


Fluoxetine Paroxetine Imipramine Sertraline Venlafaxine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    Mittmann N, Herrmann N, Einarson TR, et al. The efficacy and safety of antidepressants in late life depression: a metaanalysis. J Affect Disord 1997; 46: 191–217PubMedCrossRefGoogle Scholar
  2. 2.
    Whooley MA, Kip KE, Cauley JA, et al. Depression, falls, and risk of fracture in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1999; 159: 484–90PubMedCrossRefGoogle Scholar
  3. 3.
    Turcu A, Toubin S, Mourey F, et al. Falls and depression in older people. Gerontology 2004; 50: 303–8PubMedCrossRefGoogle Scholar
  4. 4.
    Asplund R, Johansson S, Henriksson S, et al. Nocturia, depression and antidepressant medication. BJU Int 2005; 95(6): 820–3PubMedCrossRefGoogle Scholar
  5. 5.
    Thapa PB, Gideon P, Cost TW, et al. Antidepressants and the risk of falls among nursing home residents. N Engl J Med 1998; 339: 875–82PubMedCrossRefGoogle Scholar
  6. 6.
    Hubbard R, Farrington P, Smith C, et al. Exposure to tricyclic and selective serotonin reuptake inhibitor anti-depressants and the risk of hip fracture. Am J Epidemiol 2003; 158: 77–84PubMedCrossRefGoogle Scholar
  7. 7.
    Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: 1. Psychotropic drugs. J Am Geriatr Soc 1999; 37: 30–9Google Scholar
  8. 8.
    Liu B, Anderson G, Mittmann N, et al. Use of selected serotonin reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. Lancet 1998; 351: 1303–7PubMedCrossRefGoogle Scholar
  9. 9.
    Vestergaard P, Rejnmark L, Mosekilde L. Anxiolytics, sedatives, antidepressants, neuroleptics and the risk of fracture. Osteoporos Int 2006; 17: 807–16PubMedCrossRefGoogle Scholar
  10. 10.
    Kelly KD, Pickett W, Yiannakoulias N, et al. Medication use and falls in community-dwelling older persons. Age Ageing 2003; 32: 503–9PubMedCrossRefGoogle Scholar
  11. 11.
    Ray WA, Griffin MR, Malcolm E. Cyclic antidepressants and the risk of hip fracture. Arch Intern Med 1991; 151: 754–6PubMedCrossRefGoogle Scholar
  12. 12.
    Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross-sectional study. BMJ 2003; 327: 712–7PubMedCrossRefGoogle Scholar
  13. 13.
    Ebly EM, Hogan DB, Fung TS. Potential adverse outcomes of psychotropic and narcotic drug use in Canadian seniors. J Clin Epidemiol 1997; 50(7): 857–63PubMedCrossRefGoogle Scholar
  14. 14.
    Ensrud KE, Blackwell TL, Mangione CM, et al. Central nervous system: active medications and risk for falls in older women. J Am Geriatr Soc 2002; 50: 1629–37PubMedCrossRefGoogle Scholar
  15. 15.
    Arfken CL, Wilson JG, Aronson SM. Retrospective review of selective serotonin reuptake inhibitors and falling in older nursing home residents. Int Psychogeriatr 2001; 13(1): 85–91PubMedCrossRefGoogle Scholar
  16. 16.
    Lewis CE, Ewing SK, Taylor BC, et al. Predictors of nonspine fracture in elderly men: the MrOS study. J Bone Miner Res 2007; 22: 211–9PubMedCrossRefGoogle Scholar
  17. 17.
    Kallin K, Gustafson Y, Sandman P, et al. Drugs and falls in older people in geriatric care settings. Aging Clin Exp Res 2004; 16(4): 270–6PubMedGoogle Scholar
  18. 18.
    Souchet E, Lapeyre-Mestre M, Montastruc JL. Drug related falls: a study in the French Pharmacovigilance database. Pharmacoepidemiol Drug Saf 2005; 14: 11–6PubMedCrossRefGoogle Scholar
  19. 19.
    Vassallo M, Sharma JC, Allen SC. Characteristics of single fallers and recurrent fallers among hospital inpatients. Gerontology 2002; 48: 147–50PubMedCrossRefGoogle Scholar
  20. 20.
    Richelson E, Nelson A. Antagonism by antidepressants of neurotransmitter receptors of normal human brain in vitro. J Pharmacol Exp Ther 1984; 230: 94–102PubMedGoogle Scholar
  21. 21.
    Cusack B, Nelson A, Richelson E. Binding of antidepressants to human brain receptors: focus on newer generation compounds. Psychopharmacology (Berl) 1994; 114: 559–65CrossRefGoogle Scholar
  22. 22.
    Stage KB, Kragh-Sjorensen P. Age-related adverse drug reactions to clomipramine. Acta Psychiatr Scand 2002; 105: 55–9PubMedCrossRefGoogle Scholar
  23. 23.
    Robinson DS, Nies A, Corcella J, et al. Cardiovascular effects of phenelzine and amitriptyline in depressed outpatients. J Clin Psychiatry 1982; 43: 8–15PubMedGoogle Scholar
  24. 24.
    Biswas P, Wilton LV, Shakir SA. The pharmacovigilance of mirtazapine: results of a prescription event monitoring study on 13554 patients in England. J Psychopharmacol 2003; 17: 121–6PubMedCrossRefGoogle Scholar
  25. 25.
    Muldoon C. The safety and tolerability of citalopram. Int Clin Psychopharmacol 1996; 11Suppl. 1: 35–40PubMedCrossRefGoogle Scholar
  26. 26.
    Barak Y, Swartz M, Levy D, et al. Age-related differences in the side-effect profile of citalopram. Prog Neuropsychopharmacol Bio Psychiatry 2003; 27: 545–8CrossRefGoogle Scholar
  27. 27.
    Grimsley SR, Jann MW. Paroxetine sertraline, and fluvoxamine: new selective serotonin reuptake inhibitors. Clin Pharm 1992; 11(11): 930–57PubMedGoogle Scholar
  28. 28.
    Dechant KL, Clissold SP. Paroxetine: a review. Drugs 1991; 41(2): 225–53PubMedCrossRefGoogle Scholar
  29. 29.
    Trick L, Stanley N, Rigney U, et al. A double-blind, randomized, 26-week study comparing the cognitive and psychomotor effects and efficacy of 75 mg (37.5 mg b.i.d.) venlafaxine and 75 mg (25 mg mane, 50 mg nocte) dothiepin in elderly patients with moderate major depression 393 being treated in general practice. J Psychopharmacol 2004; 18(2): 205–14PubMedCrossRefGoogle Scholar
  30. 30.
    Brunnauer A, Laux G, Geiger E, et al. Antidepressants and driving ability: results from a clinical study. J Clin Psychiatry 2006; 67(11): 1776–81PubMedCrossRefGoogle Scholar
  31. 31.
    Krystal AD, Thase ME, Tucker VL, et al. Bupropion HCl and sleep in patients with depression. Curr Psychiatry Rev 2007; 3(2): 123–8CrossRefGoogle Scholar
  32. 32.
    Asplund R, Henriksson S, Johansson S, et al. Nocturia and depression. BJU Int 2004; 93(9): 253–6CrossRefGoogle Scholar
  33. 33.
    Teo JSH, Briffa NK, Devine A, et al. Do sleep problems or urinary incontinence predict falls in elderly women? Aust J Physiother 2006; 52: 19–24PubMedCrossRefGoogle Scholar
  34. 34.
    Asplund R, Johansson S, Svante H, et al. Nocturia, depression and antidepressant medication. BJU Int 2005; 95: 820–3PubMedCrossRefGoogle Scholar
  35. 35.
    Goldman SE, Stone KL, Ancoli-Israel S. Poor sleep is associated with poorer physical performance and greater functional limitations in older women. Sleep 2007; 30(10): 1317–24PubMedGoogle Scholar
  36. 36.
    Ensrud KE, Blackwell TL, Ancoli-Israel S, et al. Use of selective serotonin reuptake inhibitors and sleep disturbances in community-dwelling older women. J Am Geriatr Soc 2006; 54(10): 1508–15PubMedCrossRefGoogle Scholar
  37. 37.
    Mayers AG, Baldwin DS. Antidepressants and their effect on sleep. Hum Psychopharmacol 2005; 20(8): 533–59PubMedCrossRefGoogle Scholar
  38. 38.
    Li X, Hamdy R, Sandborn W, et al. Long-term effects of antidepressants on balance, equilibrium and postural reflexes. Psychiatry Res 1996; 63: 191–6PubMedCrossRefGoogle Scholar
  39. 39.
    Fairweather DB, Kerr JS, Harrison DA, et al. A double blind comparison of the effects of fluoxetine and amitriptyline on cognitive function in elderly depressed patients. Human Psychopharmacol 1993; 8: 41–7CrossRefGoogle Scholar
  40. 40.
    Laghrissi-Thode F, Pollock BG, Miller M, et al. Comparative effects of sertraline and nortriptyline on body sway in older depressed patients. Am J Geriatr Psychiatry 1995; 3: 228–37CrossRefGoogle Scholar
  41. 41.
    Mamo DC, Pollock MD, Mulsani B, et al. Effects of nortriptyline and paroxetine on postural sway in depressed elderly patients. Am J Geriatr Psychiatry 2002; 10(2): 199–205PubMedGoogle Scholar
  42. 42.
    Draganich LF, Zacny J, Klafta J, et al. The effects of anti-depressants on obstructed and unobstructed gait in healthy elderly people. J Gerontol A Biol Sci Med Sci 2001; 56(1): M36–41PubMedCrossRefGoogle Scholar
  43. 43.
    Heitterachi E, Lord SR, Meyerkort P, et al. Blood pressure changes on upright tilting predict falls in older people. Age Ageing 2002; 31: 181–6PubMedCrossRefGoogle Scholar
  44. 44.
    Graafmans WC, Ooms ME, Hofstee HMA, et al. Falls in the elderly: A prospective study of risk factors and risk profiles. Am J Epidemiol 1996; 142(11): 1129–36CrossRefGoogle Scholar
  45. 45.
    Poon IO, Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 2005; 30: 173–8PubMedCrossRefGoogle Scholar
  46. 46.
    Ooi W, Hossain M, Lipsitz LA. The association between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med 2000; 108: 106–11PubMedCrossRefGoogle Scholar
  47. 47.
    Hayes JR, Born GF, Rosenbaum AH. Incidence of orthostatic hypotension in patients with primary affective disorders treated with tricyclic antidepressants. Mayo Clin Proc 1977; 52: 509–12PubMedGoogle Scholar
  48. 48.
    Glassman AH, Bigger JT, Giardina EV, et al. Clinical characteristics of imipramine induced orthostatic hypotension. Lancet 1979; 1(8114): 468–72PubMedCrossRefGoogle Scholar
  49. 49.
    Glassman AH, Bigger JT. Cardiovascular effects of therapeutic doses of tricyclic antidepressants: a review. Arch Gen Psychiatry 1982; 38: 815–20CrossRefGoogle Scholar
  50. 50.
    Glassman AH. Cardiovascular effects of antidepressant drugs: updated. Int Clin Psychopharmacol 1998; 13Suppl. 5: S25–30PubMedCrossRefGoogle Scholar
  51. 51.
    Glassman AH, Johnson LL, Giardina EV, et al. The use of imipramine in depressed patients with congestive cardiac failure. JAMA 1983; 250(15): 1997–2001PubMedCrossRefGoogle Scholar
  52. 52.
    Roose SP, Glassman AH, Giardina EV, et al. Nortriptyline in depressed patients with left ventricular impairment. JAMA 1986; 256(23): 3253–7PubMedCrossRefGoogle Scholar
  53. 53.
    Miller MD, Pollock BG, Rifai AH, et al. Longitudinal analysis of nortriptyline side effects in elderly depressed patients. J Geriatr Psychiatry Neurol 1991; 4: 226–30PubMedCrossRefGoogle Scholar
  54. 54.
    Farid FF, Wenger TL, Tsai SY, et al. Use of bupropion in patients who exhibit orthostatic hypotension on tricyclic antidepressants. J Clin Psychiatry 1983; 44 (5 Pt 2): 170–3PubMedGoogle Scholar
  55. 55.
    Roose SP, Dalack GW, Glassman AH, et al. Cardiovascular effects of bupropion in depressed patients with heart disease. Am J Psychiatry 1991; 148(4): 512–6PubMedGoogle Scholar
  56. 56.
    Moller M, Thayssen P, Kragh-Sorensen P, et al. Mianserin: cardiovascular effects in elderly patients. Psychopharmacology 1983; 80: 174–7PubMedCrossRefGoogle Scholar
  57. 57.
    Coupland NJ, Wilson SJ, Potokar JP, et al. A comparison of the effects of phenelzine treatment with moclobemide treatment on cardiovascular reflexes. Int Clin Psychopharmacol 1995; 10: 229–38PubMedCrossRefGoogle Scholar
  58. 58.
    Rabkin JG, Quitkin M, Harrison W, et al. Adverse reactions to monoamine oxidase inhibitors: part 1. A comparative study. J Clin Psychopharmacol 1984; 4: 270–8PubMedCrossRefGoogle Scholar
  59. 59.
    Stage KB. Orthostatic side effects of clomipramine and moclobemide during treatment for depression. Nord J Psychiatry 2005; 59: 298–301PubMedCrossRefGoogle Scholar
  60. 60.
    Koczkas C, Holm A, Karlsson A, et al. Moclobemide and clomipramine in endogenous depression: a randomised clinical trial. Acta Psychiatr Scand 1989; 79: 523–9PubMedCrossRefGoogle Scholar
  61. 61.
    Delini-Stula A, Baier D, Kohnen R, et al. Undesirable blood pressure changes under naturalistic treatment with moclobemide, a reversible MAO-A inhibitor: results of the drug utilization observation studies. Pharmacopsychiatry 1999; 32: 61–7PubMedCrossRefGoogle Scholar
  62. 62.
    Joo BA, Lenze EJ, Mulsant BH, et al. Risk factors for falls during treatment of late life depression. J Clin Psychiatry 2002; 63(10): 936–41PubMedCrossRefGoogle Scholar
  63. 63.
    Andrews C, Pinner G. Postural hypotension induced by paroxetine. BMJ 1998; 316: 595PubMedCrossRefGoogle Scholar
  64. 64.
    Johnson EM, Whyte E, Mulsant BH, et al. Cardiovascular changes associated with venlafaxine in the treatment of late life depression. Am J Geriatr Psychiatry 2006; 14(9): 796–802PubMedCrossRefGoogle Scholar
  65. 65.
    Kok R, Nolen W, Heeren T. Cardiovascular changes associated with venlafaxine in the treatment of late life depression [letter]. Am J Geriatr Psychiatry 2007; 15(8): 725PubMedCrossRefGoogle Scholar
  66. 66.
    Wernicke J, Lledo A, Raskin J, et al. An evaluation of the cardiovascular safety profile of duloxetine: findings 394 from 42 placebo-controlled studies. Drug Saf 2007; 30(5): 437–55PubMedCrossRefGoogle Scholar
  67. 67.
    Raskin J, Wiltse CG, Dinkel JJ, et al. Safety and tolerability of duloxetine at 60 mg once daily in elderly patients with major depressive disorder. J Clin Psychopharmacol 2008; 28(1): 32–8PubMedCrossRefGoogle Scholar
  68. 68.
    Berzewski H, Van Moffaert M, Gagiano CA. Efficacy and tolerability of reboxetine compared with imipramine in a double-blind study in patients suffering from major depressive episodes. Eur Neuropsychopharmacol 1997; 7Suppl. 1: S37–47PubMedCrossRefGoogle Scholar
  69. 69.
    Versiani M, Amin M, Chouinard G. Double-blind, Placebo-controlled study with reboxetine in inpatients with severe major depressive disorder. J Clin Psychopharmacol 2000; 20: 28–34PubMedCrossRefGoogle Scholar
  70. 70.
    Witchel HJ, Hancox JC, Nutt DJ. Psychotropic drugs, cardiac arrhythmia, and sudden death. J Clin Psychopharmacol 2003; 23: 58–77PubMedCrossRefGoogle Scholar
  71. 71.
    Pacher P, Kecskemeti V. Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns. Curr Pharm Des 2004; 10: 2463–75PubMedCrossRefGoogle Scholar
  72. 72.
    Roose SP, Glassman AH, Giardina EV, et al. Tricyclic anti-depressants in depressed patients with cardiac conduction disease. Arch Gen Psychiatry 1987; 44(3): 273–5PubMedCrossRefGoogle Scholar
  73. 73.
    Gambassi G, Incalzi R. Atrioventricular blocks associated with citalopram. Am J Geriatr Psychiatry 2005; 13(10): 918–9PubMedGoogle Scholar
  74. 74.
    Gardner SF, Rutherford WF, Munger MA, et al. Drug-induced supraventricular tachycardia: a case report of fluoxetine. Ann Emerg Med 1991; 20: 194–7PubMedCrossRefGoogle Scholar
  75. 75.
    McAnally LE, Threlkeld KR, Dreyling CA. Case report of a syncopal episode associated with fluoxetine. Ann Pharmacother 1992; 26(9): 1090–1PubMedGoogle Scholar
  76. 76.
    Ellison JM, Milofsky JE, Ely E. Fluoxetine-induced bradycardia and syncope in two patients. J Clin Psychiatry 1990; 51(9): 385–6PubMedGoogle Scholar
  77. 77.
    Feder R. Bradycardia and syncope induced by fluoxetine. J Clin Psychiatry 1991; 52(3): 139PubMedGoogle Scholar
  78. 78.
    Cherin P, Colvez A, Deville de Perriere GD, et al. Risk of syncope in the elderly and consumption of drugs: a case control study. J Clin Epidemiol 1997; 50(3): 313–20PubMedCrossRefGoogle Scholar
  79. 79.
    Sleeper R, Bond CA, Rojas-Fernandez C. Psychotropic drugs and falls: new evidence pertaining to serotonin reuptake inhibitors. Pharmacotherapy 2000; 20: 308–17PubMedCrossRefGoogle Scholar
  80. 80.
    Saag K. Mend the mind but mind the bones. Arch Int Med 2007; 167: 1231–2CrossRefGoogle Scholar
  81. 81.
    Williams LJ, Henry MJ, Berk M, et al. SSRI use and bone mineral density in women with a history of depression. Int Clin Psychopharmacol 2008; 23(2): 84–7PubMedCrossRefGoogle Scholar
  82. 82.
    Haney EM, Chan BK, Diem SJ, et al. Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch Intern Med 2007; 167(12): 1246–51PubMedCrossRefGoogle Scholar
  83. 83.
    Diem SJ, Blackwell TL, Stone KL, et al. Use of anti-depressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med 2007; 167(12): 1240–5PubMedCrossRefGoogle Scholar
  84. 84.
    Demyttenaere K, Jaspers L. Bupropion and SSRI-induced side effects. J Psychopharmacol 2008; 22(7): 792–804PubMedCrossRefGoogle Scholar
  85. 85.
    Beyens MN, Guy C, Mounier G, et al. Serious adverse reactions of bupropion for smoking cessation: analysis of the French Pharmacovigilance Database from 2001 to 2004. Drug Saf 2008; 31(11): 1017–26PubMedCrossRefGoogle Scholar
  86. 86.
    Mayers AG, Baldwin DS. Antidepressants and their effect on sleep. Hum Psychopharmacol 2005; 20(8): 533–59PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Adam Darowski
    • 1
    Email author
  • Sally-Ann C. F. Chambers
    • 2
  • David J. Chambers
    • 2
  1. 1.John Radcliffe HospitalHeadington, OxfordUK
  2. 2.University Hospital of North StaffordshireStoke-on-Trent, StaffordshireUK

Personalised recommendations