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Psychotropic Drugs

Abstract

Available evidence suggests that antidepressants, antipsychotics, lithium, and antiepileptic drugs can increase the risks for falls and fractures in older adults. However, the relationship between falls and psychotropic medications is complex because the mental disorders treated with these psychotropic medications and their comorbidities are themselves significant and independent risk factors for falls. Thus, fall risk by itself is not a contraindication for the use of psychotropic medications in an older frail patient. Nevertheless, clinicians need to prescribe these medications judiciously and to follow principles of conservative prescribing to minimize the risk for falls. While some psychotropic medications may have a direct effect on balance, most falls and fractures are related to other side effects, in particular, orthostatic change in blood pressure, pro-arrhythmogenic effects, extrapyramidal symptoms (including Parkinsonism and akathisia), sedation, and cognitive impairment. Thus, careful selection of specific medications based on their differential side effect profile and monitoring of adverse effects is mandatory. Close monitoring is particularly important during the first few days or weeks after starting a new psychotropic medication or after a dose increase.

Keywords

  • Psychotropic Medication
  • Atypical Antipsychotic
  • Tardive Dyskinesia
  • Behavioral Symptom
  • Fall Risk

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.

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Fig. 9.1

Abbreviations

AED:

Antiepileptic drug

AGS:

American Geriatrics Society

aRR:

Adjusted relative risk

CI:

Confidence interval

DEXA:

Dual-energy x-ray absorptiometry

EPS:

Extrapyramidal signs and symptoms

OR:

Odds ratio

PIM:

Potentially inappropriate medications

SSRI:

Selective serotonin reuptake inhibitors

TCA:

Tricyclic antidepressants

TD:

Tardive dyskinesia

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Iaboni, A., Mulsant, B.H. (2016). Psychotropic Drugs. In: Huang, A., Mallet, L. (eds) Medication-Related Falls in Older People. Adis, Cham. https://doi.org/10.1007/978-3-319-32304-6_9

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