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Psychotropic Drugs

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Medication-Related Falls in Older People

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.

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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

References

  1. American Geriatrics Society 2015 Beers Criteria Update Expert Panel (2015) American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 63:2227–2246

    Article  Google Scholar 

  2. Anstey KJ, Burns R, von Sanden C, Luszcz MA (2008) Psychological well-being is an independent predictor of falling in an 8-year follow-up of older adults. J Gerontol B Psychol Sci Soc Sci 63:249–257

    Article  Google Scholar 

  3. Bakken MS, Engeland A, Engesaeter LB, Ranhoff AH, Hunskaar S, Ruths S (2013) Increased risk of hip fracture among older people using antidepressant drugs: data from the Norwegian prescription database and the Norwegian hip fracture registry. Age Ageing 42:514–520

    Article  PubMed  Google Scholar 

  4. Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K, Gill R, Juszczak E, Yu LM, Jacoby R et al (2009) The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol 8:151–157

    Article  CAS  PubMed  Google Scholar 

  5. Barone P, Scarzella L, Marconi R, Antonini A, Morgante L, Bracco F, Zappia M, Musch B, Depression/Parkinson Italian Study Group (2006) Pramipexole versus sertraline in the treatment of depression in Parkinson’s disease: a national multicenter parallel-group randomized study. J Neurol 253:601–607

    Article  CAS  PubMed  Google Scholar 

  6. Beekman AT, Deeg DJ, van Tilburg T, Smit JH, Hooijer C, van Tilburg W (1995) Major and minor depression in later life: a study of prevalence and risk factors. J Affect Disord 36:65–75

    Article  CAS  PubMed  Google Scholar 

  7. Biderman A, Cwikel J, Fried AV, Galinsky D (2002) Depression and falls among community dwelling elderly people: a search for common risk factors. J Epidemiol Community Health 56:631–636

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Bolton JM, Metge C, Lix L, Prior H, Sareen J, Leslie WD (2008) Fracture risk from psychotropic medications: a population-based analysis. J Clin Psychopharmacol 28:384–391

    Article  PubMed  Google Scholar 

  9. Bozat-Emre S, Doupe M, Kozyrskyj AL, Grymonpre R, Mahmud SM (2015) Atypical antipsychotic drug use and falls among nursing home residents in Winnipeg, Canada. Int J Geriatr Psychiatry 30:842–850

    Article  PubMed  Google Scholar 

  10. Caligiuri MP, Lacro JP, Jeste DV (1999) Incidence and predictors of drug-induced parkinsonism in older psychiatric patients treated with very low doses of neuroleptics. J Clin Psychopharmacol 19:322–328

    Article  CAS  PubMed  Google Scholar 

  11. Caligiuri MR, Jeste DV, Lacro JP (2000) Antipsychotic-induced movement disorders in the elderly: epidemiology and treatment recommendations. Drugs Aging 17:363–384

    Article  CAS  PubMed  Google Scholar 

  12. Chen P, Kales HC, Weintraub D, Blow FC, Jiang L, Mellow AM (2007) Antidepressant treatment of veterans with Parkinson’s disease and depression: analysis of a national sample. J Geriatr Psychiatry Neurol 20:161–165

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Mahmoud RA, Kirshner MA, Sorisio DA, Bies RR, Gharabawi G (2008) Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 56:1333–1341

    Article  PubMed  Google Scholar 

  14. Clement-Lacroix P, Ai M, Morvan F, Roman-Roman S, Vayssiere B, Belleville C, Estrera K, Warman ML, Baron R, Rawadi G (2005) Lrp5-independent activation of wnt signaling by lithium chloride increases bone formation and bone mass in mice. Proc Natl Acad Sci U S A 102:17406–17411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cohen A, Lancman M, Mogul H, Marks S, Smith K (1997) Strategies to protect bone mass in the older patient with epilepsy. Geriatrics 52(8):70, 75–78, 81

    Google Scholar 

  16. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R, National Osteoporosis Foundation (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  18. Culang ME, Sneed JR, Keilp JG, Rutherford BR, Pelton GH, Devanand DP, Roose SP (2009) Change in cognitive functioning following acute antidepressant treatment in late-life depression. Am J Geriatr Psychiatry 17:881–888

    Article  PubMed  PubMed Central  Google Scholar 

  19. Deberdt WG, Dysken MW, Rappaport SA, Feldman PD, Young CA, Hay DP, Lehman DL, Dossenbach M, Degenhardt EK, Breier A (2005) Comparison of olanzapine and risperidone in the treatment of psychosis and associated behavioral disturbances in patients with dementia. Am J Geriatr Psychiatry 13:722–730

    Article  PubMed  Google Scholar 

  20. Declercq T, Petrovic M, Azermai M, Vander Stichele R, De Sutter AI, van Driel ML, Christiaens T (2013) Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev (3):CD007726

    Google Scholar 

  21. Devos D, Dujardin K, Poirot I, Moreau C, Cottencin O, Thomas P, Destee A, Bordet R, Defebvre L (2008) Comparison of desipramine and citalopram treatments for depression in parkinson’s disease: a double-blind, randomized, placebo-controlled study. Mov Disord 23:850–857

    Article  PubMed  Google Scholar 

  22. Diem SJ, Blackwell TL, Stone KL, Yaffe K, Cauley JA, Whooley MA, Ensrud KE, Study of Osteoporotic Fractures (2007) Depressive symptoms and rates of bone loss at the hip in older women. J Am Geriatr Soc 55:824–831

    Article  PubMed  Google Scholar 

  23. D’Souza R, Rajji TK, Mulsant BH, Pollock BG (2011) Use of lithium in the treatment of bipolar disorder in late-life. Curr Psychiatry Rep 13:488–492

    Article  PubMed  Google Scholar 

  24. Ensrud KE, Blackwell T, Mangione CM, Bowman PJ, Bauer DC, Schwartz A, Hanlon JT, Nevitt MC, Whooley MA (2003) Central nervous system active medications and risk for fractures in older women. Arch Intern Med 163:949–957

    Article  PubMed  Google Scholar 

  25. Ensrud KE, Blackwell TL, Mangione CM, Bowman PJ, Whooley MA, Bauer DC, Schwartz AV, Hanlon JT, Nevitt MC (2002) Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc 50:1629–1637

    Article  PubMed  Google Scholar 

  26. Fabian TJ, Amico JA, Kroboth PD, Mulsant BH, Corey SE, Begley AE, Bensasi SG, Weber E, Dew MA, Reynolds CF 3rd et al (2004) Paroxetine-induced hyponatremia in older adults: a 12-week prospective study. Arch Intern Med 164:327–332

    Article  CAS  PubMed  Google Scholar 

  27. Fife TD, Blum D, Fisher RS (2006) Measuring the effects of antiepileptic medications on balance in older people. Epilepsy Res 70:103–109

    Article  CAS  PubMed  Google Scholar 

  28. Gagne JJ, Patrick AR, Mogun H, Solomon DH (2011) Antidepressants and fracture risk in older adults: a comparative safety analysis. Clin Pharmacol Ther 89:880–887

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Garfield LD, Muller DJ, Kennedy JL, Mulsant BH, Reynolds CF 3rd, Teitelbaum SL, Civitelli R, Dixon D, Todorov AA, Lenze EJ (2014) Genetic variation in the serotonin transporter and HTR1B receptor predicts reduced bone formation during serotonin reuptake inhibitor treatment in older adults. World J Biol Psychiatry 15:404–410

    Article  PubMed  Google Scholar 

  30. Gebara MA, Lipsey KL, Karp JF, Nash MC, Iaboni A, Lenze EJ (2015) Cause or effect? Selective serotonin reuptake inhibitors and falls in older adults: a systematic review. Am J Geriatr Psychiatry 23:1016–1028

    Article  PubMed  Google Scholar 

  31. Gebara MA, Shea ML, Lipsey KL, Teitelbaum SL, Civitelli R, Muller DJ, Reynolds CF 3rd, Mulsant BH, Lenze EJ (2014) Depression, antidepressants, and bone health in older adults: a systematic review. J Am Geriatr Soc 62:1434–1441

    Article  PubMed  PubMed Central  Google Scholar 

  32. Gildengers AG, Butters MA, Chisholm D, Anderson SJ, Begley A, Holm M, Rogers JC, Reynolds CF 3rd, Mulsant BH (2012) Cognition in older adults with bipolar disorder versus major depressive disorder. Bipolar Disord 14:198–205

    Article  PubMed  PubMed Central  Google Scholar 

  33. Graff-Guerrero A, Rajji TK, Mulsant BH, Nakajima S, Caravaggio F, Suzuki T, Uchida H, Gerretsen P, Mar W, Pollock BG et al (2015) Evaluation of antipsychotic dose reduction in late-life schizophrenia: a prospective dopamine D2/3 receptor occupancy study. JAMA Psychiatry 72:927–934

    Article  PubMed  Google Scholar 

  34. Gribbin J, Hubbard R, Gladman J, Smith C, Lewis S (2011) Serotonin-norepinephrine reuptake inhibitor antidepressants and the risk of falls in older people: case-control and case-series analysis of a large UK primary care database. Drugs Aging 28:895–902

    Article  CAS  PubMed  Google Scholar 

  35. Hajjar I, Yang F, Sorond F, Jones RN, Milberg W, Cupples LA, Lipsitz LA (2009) A novel aging phenotype of slow gait, impaired executive function, and depressive symptoms: relationship to blood pressure and other cardiovascular risks. J Gerontol A Biol Sci Med Sci 64:994–1001

    Article  PubMed  Google Scholar 

  36. Hausdorff JM, Rios DA, Edelberg HK (2001) Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 82:1050–1056

    Article  CAS  PubMed  Google Scholar 

  37. Hausdorff JM, Peng CK, Goldberger AL, Stoll AL (2004) Gait unsteadiness and fall risk in two affective disorders: a preliminary study. BMC Psychiatry 4:39

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hawthorne JM, Caley CF (2015) Extrapyramidal reactions associated with serotonergic antidepressants. Ann Pharmacother 49:1136–1152

    Article  CAS  PubMed  Google Scholar 

  39. Hien le TT, Cumming RG, Cameron ID, Chen JS, Lord SR, March LM, Schwarz J, Le Couteur DG, Sambrook PN (2005) Atypical antipsychotic medications and risk of falls in residents of aged care facilities. J Am Geriatr Soc 53:1290–1295

    Article  CAS  PubMed  Google Scholar 

  40. Hubbard R, Farrington P, Smith C, Smeeth L, Tattersfield A (2003) Exposure to tricyclic and selective serotonin reuptake inhibitor antidepressants and the risk of hip fracture. Am J Epidemiol 158:77–84

    Article  PubMed  Google Scholar 

  41. Huybrechts KF, Schneeweiss S, Gerhard T, Olfson M, Avorn J, Levin R, Lucas JA, Crystal S (2012) Comparative safety of antipsychotic medications in nursing home residents. J Am Geriatr Soc 60:420–429

    Article  PubMed  PubMed Central  Google Scholar 

  42. Iaboni A, Flint AJ (2013) The complex interplay of depression and falls in older adults: a clinical review. Am J Geriatr Psychiatry 21:484–492

    Article  PubMed  PubMed Central  Google Scholar 

  43. Jalbert JJ, Eaton CB, Miller SC, Lapane KL (2010) Antipsychotic use and the risk of hip fracture among older adults afflicted with dementia. J Am Med Dir Assoc 11:120–127

    Article  PubMed  Google Scholar 

  44. Joo JH, Lenze EJ, Mulsant BH, Begley AE, Weber EM, Stack JA, Mazumdar S, Reynolds CF 3rd, Pollock BG (2002) Risk factors for falls during treatment of late-life depression. J Clin Psychiatry 63:936–941

    Article  PubMed  Google Scholar 

  45. Katz IR (2004) Optimizing atypical antipsychotic treatment strategies in the elderly. J Am Geriatr Soc 52:S272–S277

    Article  PubMed  Google Scholar 

  46. Kinon BJ, Stauffer VL, McGuire HC, Kaiser CJ, Dickson RA, Kennedy JS (2003) The effects of antipsychotic drug treatment on prolactin concentrations in elderly patients. J Am Med Dir Assoc 4:189–194

    Article  PubMed  Google Scholar 

  47. Kishimoto T, De Hert M, Carlson HE, Manu P, Correll CU (2012) Osteoporosis and fracture risk in people with schizophrenia. Curr Opin Psychiatry 25:415–429

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kvelde T, Lord SR, Close JC, Reppermund S, Kochan NA, Sachdev P, Brodaty H, Delbaere K (2015) Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning. Arch Gerontol Geriatr 60:190–195

    Article  PubMed  Google Scholar 

  49. Laghrissi-Thode F, Pollock BG, Miller M, Altieri L, Kupfer DJ (1995) Comparative effects of sertraline and nortriptyline on body sway in older depressed patients. Am J Geriatr Psychiatry 3:217–228

    Article  Google Scholar 

  50. Lakey SL, LaCroix AZ, Gray SL, Borson S, Williams CD, Calhoun D, Goveas JS, Smoller JW, Ockene JK, Masaki KH et al (2012) Antidepressant use, depressive symptoms, and incident frailty in women aged 65 and older from the women’s health initiative observational study. J Am Geriatr Soc 60:854–861

    Article  PubMed  PubMed Central  Google Scholar 

  51. Landi F, Onder G, Cesari M, Barillaro C, Russo A, Bernabei R, Silver Network Home Care Study Group (2005) Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. J Gerontol A Biol Sci Med Sci 60:622–626

    Article  PubMed  Google Scholar 

  52. Lavsa SM, Fabian TJ, Saul MI, Corman SL, Coley KC (2010) Influence of medications and diagnoses on fall risk in psychiatric inpatients. Am J Health Syst Pharm 67:1274–1280

    Article  PubMed  Google Scholar 

  53. Lee D, Martini N, Moyes S, Hayman K, Zolezzi M, Kerse N (2013) Potentially inappropriate medication use: the Beers’ criteria used among older adults with depressive symptoms. J Prim Health Care 5:182–190

    PubMed  Google Scholar 

  54. Lee PE, Gill SS, Freedman M, Bronskill SE, Hillmer MP, Rochon PA (2004) Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ 329:75

    Article  PubMed  PubMed Central  Google Scholar 

  55. Lenze EJ, Mulsant BH, Blumberger DM, Karp JF, Newcomer JW, Anderson SJ, Dew MA, Butters MA, Stack JA, Begley AE et al (2015) Efficacy, safety, and tolerability of augmentation pharmacotherapy with aripiprazole for treatment-resistant depression in late life: a randomised, double-blind, placebo-controlled trial. Lancet 386:2404–12

    Google Scholar 

  56. Liperoti R, Onder G, Lapane KL, Mor V, Friedman JH, Bernabei R, Gambassi G (2007) Conventional or atypical antipsychotics and the risk of femur fracture among elderly patients: results of a case-control study. J Clin Psychiatry 68:929–934

    Article  CAS  PubMed  Google Scholar 

  57. Liu B, Anderson G, Mittmann N, To T, Axcell T, Shear N (1998) Use of selective serotonin-reuptake inhibitors of tricyclic antidepressants and risk of hip fractures in elderly people. Lancet 351:1303–1307

    Article  CAS  PubMed  Google Scholar 

  58. Madhusoodanan S, Zaveri D (2010) Paliperidone use in the elderly. Curr Drug Saf 5:149–152

    Article  CAS  PubMed  Google Scholar 

  59. Majic T, Pluta JP, Mell T, Treusch Y, Gutzmann H, Rapp MA (2012) Correlates of agitation and depression in nursing home residents with dementia. Int Psychogeriatr 24:1779–1789

    Article  PubMed  Google Scholar 

  60. Maki BE (1997) Gait changes in older adults: predictors of falls or indicators of fear. J Am Geriatr Soc 45:313–320

    Article  CAS  PubMed  Google Scholar 

  61. Mamo DC, Pollock BG, Mulsant B, Houck PR, Bensasi S, Miller MC, Redfern MS, Reynolds CF III (2002) Effects of nortriptyline and paroxetine on postural sway in depressed elderly patients. Am J Geriatr Psychiatry 10:199–205

    Article  PubMed  Google Scholar 

  62. Mamo DC, Sweet RA, Mulsant BH, Pollock BG, Miller MD, Stack JA, Begley AE, Reynolds CF 3rd (2000) Effect of nortriptyline and paroxetine on extrapyramidal signs and symptoms: a prospective double-blind study in depressed elderly patients. Am J Geriatr Psychiatry 8:226–231

    Article  CAS  PubMed  Google Scholar 

  63. McDermott LM, Ebmeier KP (2009) A meta-analysis of depression severity and cognitive function. J Affect Disord 119:1–8

    Article  PubMed  Google Scholar 

  64. Michalak J, Troje NF, Fischer J, Vollmar P, Heidenreich T, Schulte D (2009) Embodiment of sadness and depression – gait patterns associated with dysphoric mood. Psychosom Med 71:580–587

    Article  PubMed  Google Scholar 

  65. Miller RR, Ballew SH, Shardell MD, Hicks GE, Hawkes WG, Resnick B, Magaziner J (2009) Repeat falls and the recovery of social participation in the year post-hip fracture. Age Ageing 38:570–575

    Article  PubMed  PubMed Central  Google Scholar 

  66. Mitchell AJ, Malone D, Doebbeling CC (2009) Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies. Br J Psychiatry 194:491–499

    Article  PubMed  Google Scholar 

  67. Mulsant BH, Pollock BG (2015) Psychopharmacology. In: Steffens DC, Blazer DG, Thakur ME (eds) Textbook of geriatric psychiatry, 5th edn. American Psychiatric Publishing, Arlington

    Google Scholar 

  68. Mulsant BH (2014) Challenges of the treatment of neuropsychiatric symptoms associated with dementia. Am J Geriatr Psychiatry 22:317–320

    Article  PubMed  Google Scholar 

  69. Mulsant BH, Ganguli M (1999) Epidemiology and diagnosis of depression in late life. J Clin Psychiatry 60(Suppl 20):9–15

    PubMed  Google Scholar 

  70. Nagane A, Baba H, Nakano Y, Maeshima H, Hukatsu M, Ozawa K, Suzuki T, Arai H (2014) Comparative study of cognitive impairment between medicated and medication-free patients with remitted major depression: class-specific influence by tricyclic antidepressants and newer antidepressants. Psychiatry Res 218:101–105

    Article  PubMed  Google Scholar 

  71. Oderda LH, Young JR, Asche CV, Pepper GA (2012) Psychotropic-related hip fractures: meta-analysis of first-generation and second-generation antidepressant and antipsychotic drugs. Ann Pharmacother 46:917–928

    Article  PubMed  CAS  Google Scholar 

  72. Olazarán J, Valle D, Serra JA, Cano P, Muñiz R (2013) Psychotropic medications and falls in nursing homes: a cross-sectional study. J Am Med Dir Assoc 14:213–217

    Article  PubMed  Google Scholar 

  73. Olfson M, Marcus SC (2009) National patterns in antidepressant medication treatment. Arch Gen Psychiatry 66:848–856

    Article  PubMed  Google Scholar 

  74. Onder G, Liperoti R, Fialova D, Topinkova E, Tosato M, Danese P, Gallo PF, Carpenter I, Finne-Soveri H, Gindin J et al (2012) Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci 67:698–704

    Article  PubMed  Google Scholar 

  75. Paleacu D, Shutzman A, Giladi N, Herman T, Simon ES, Hausdorff JM (2007) Effects of pharmacological therapy on gait and cognitive function in depressed patients. Clin Neuropharmacol 30:63–71

    Article  CAS  PubMed  Google Scholar 

  76. Pan YJ, Wu CS, Gau SS, Chan HY, Banerjee S (2014) Antipsychotic discontinuation in patients with dementia: a systematic review and meta-analysis of published randomized controlled studies. Dement Geriatr Cogn Disord 37:125–140

    Article  PubMed  Google Scholar 

  77. Payne RA, Abel GA, Simpson CR, Maxwell SR (2013) Association between prescribing of cardiovascular and psychotropic medications and hospital admission for falls or fractures. Drugs Aging 30:247–254

    Article  PubMed  Google Scholar 

  78. Perucca E, Berlowitz D, Birnbaum A, Cloyd JC, Garrard J, Hanlon JT, Levy RH, Pugh MJ (2006) Pharmacological and clinical aspects of antiepileptic drug use in the elderly. Epilepsy Res 68(Suppl 1):S49–S63

    Article  CAS  PubMed  Google Scholar 

  79. Porsteinsson AP, Drye LT, Pollock BG, Devanand DP, Frangakis C, Ismail Z, Marano C, Meinert CL, Mintzer JE, Munro CA et al (2014) Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA 311:682–691

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Pratt N, Roughead EE, Salter A, Ryan P (2012) Choice of observational study design impacts on measurement of antipsychotic risks in the elderly: a systematic review. BMC Med Res Methodol 12:72

    Article  PubMed  PubMed Central  Google Scholar 

  81. Pratt N, Roughead EE, Ramsay E, Salter A, Ryan P (2011) Risk of hospitalization for hip fracture and pneumonia associated with antipsychotic prescribing in the elderly: a self-controlled case-series analysis in an Australian health care claims database. Drug Saf 34:567–575

    Article  PubMed  Google Scholar 

  82. Prieto-Alhambra D, Petri H, Goldenberg JS, Khong TP, Klungel OH, Robinson NJ, de Vries F (2014) Excess risk of hip fractures attributable to the use of antidepressants in five European countries and the USA. Osteoporos Int 25:847–855

    Article  CAS  PubMed  Google Scholar 

  83. Richards JB, Papaioannou A, Adachi JD, Joseph L, Whitson HE, Prior JC, Goltzman D, Canadian Multicentre Osteoporosis Study Research Group (2007) Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med 167:188–194

    Article  CAS  PubMed  Google Scholar 

  84. Richardson K, Bennett K, Kenny RA (2015) Polypharmacy including falls risk-increasing medications and subsequent falls in community-dwelling middle-aged and older adults. Age Ageing 44:90–96

    Article  PubMed  Google Scholar 

  85. Rochon PA, Stukel TA, Sykora K, Gill S, Garfinkel S, Anderson GM, Normand SL, Mamdani M, Lee PE, Li P et al (2005) Atypical antipsychotics and parkinsonism. Arch Intern Med 165:1882–1888

    Article  CAS  PubMed  Google Scholar 

  86. Rosen CJ (2009) Bone: serotonin, leptin and the central control of bone remodeling. Nat Rev Rheumatol 5:657–658

    Article  CAS  PubMed  Google Scholar 

  87. Sandhu HS, Gilles E, DeVita MV, Panagopoulos G, Michelis MF (2009) Hyponatremia associated with large-bone fracture in elderly patients. Int Urol Nephrol 41:733–737

    Article  PubMed  Google Scholar 

  88. Schiff GD, Galanter WL, Duhig J, Lodolce AE, Koronkowski MJ, Lambert BL (2011) Principles of conservative prescribing. Arch Intern Med 171:1433–1440

    Article  PubMed  Google Scholar 

  89. Schneider LS, Dagerman K, Insel PS (2006) Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry 14:191–210

    Article  PubMed  Google Scholar 

  90. Shahar D, Levi M, Kurtz I, Shany S, Zvili I, Mualleme E, Shahar A, Sarid O, Melzer I (2009) Nutritional status in relation to balance and falls in the elderly: a preliminary look at serum folate. Ann Nutr Metab 54:59–66

    Article  CAS  PubMed  Google Scholar 

  91. Shea MLO, Garfield LD, Teitelbaum S, Civitelli R, Mulsant BH, Reynolds III CF, Dixon D, Doré P, Lenze EJ (2013) Serotonin-norepinephrine reuptake inhibitor therapy in late-life depression is associated with increased marker of bone resorption. Osteoporos Int 24:1741–9

    Google Scholar 

  92. Shen C, Chen F, Zhang Y, Guo Y, Ding M (2014) Association between use of antiepileptic drugs and fracture risk: a systematic review and meta-analysis. Bone 64:246–253

    Article  CAS  PubMed  Google Scholar 

  93. Sirven JI, Fife TD, Wingerchuk DM, Drazkowski JF (2007) Second-generation antiepileptic drugs’ impact on balance: a meta-analysis. Mayo Clin Proc 82:40–47

    Article  CAS  PubMed  Google Scholar 

  94. Skapinakis P, Bakola E, Salanti G, Lewis G, Kyritsis AP, Mavreas V (2010) Efficacy and acceptability of selective serotonin reuptake inhibitors for the treatment of depression in Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. BMC Neurol 10(1):1–11; doi:10.1186/1147-2377-10-49

  95. Somadder M, Mondal S, Kersh R, Abdelhafiz AH (2007) Are recurrent fallers depressed? J Am Geriatr Soc 55:2097–2099

    Google Scholar 

  96. Spangler L, Scholes D, Brunner RL, Robbins J, Reed SD, Newton KM, Melville JL, Lacroix AZ (2008) Depressive symptoms, bone loss, and fractures in postmenopausal women. J Gen Intern Med 23:567–574

    Article  PubMed  PubMed Central  Google Scholar 

  97. Stone KL, Ancoli-Israel S, Blackwell T, Ensrud KE, Cauley JA, Redline S, Hillier TA, Schneider J, Claman D, Cummings SR (2008) Actigraphy-measured sleep characteristics and risk of falls in older women. Arch Intern Med 168:1768–1775

    Article  PubMed  Google Scholar 

  98. Tan L, Tan L, Wang HF, Wang J, Tan CC, Tan MS, Meng XF, Wang C, Yu JT (2015) Efficacy and safety of atypical antipsychotic drug treatment for dementia: a systematic review and meta-analysis. Alzheimers Res Ther 7:20, 015-0102-9.

    Google Scholar 

  99. Thapa PB, Gideon P, Cost TW, Milam AB, Ray WA (1998) Antidepressants and the risk of falls among nursing home residents. N Engl J Med 339:875–882

    Article  CAS  PubMed  Google Scholar 

  100. Thorell K, Ranstad K, Midlov P, Borgquist L, Halling A (2014) Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level: a cohort study. BMC Geriatr 14:131; doi:10.1186/1471-2318-14-131

  101. Thorlund K, Druyts E, Wu P, Balijepalli C, Keohane D, Mills E (2015) Comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults: a network meta-analysis. J Am Geriatr Soc 63:1002–1009

    Article  PubMed  Google Scholar 

  102. Tseng YL, Huang CR, Lin CH, Lu YT, Lu CH, Chen NC, Chang CC, Chang WN, Chuang YC (2014) Risk factors of hyperammonemia in patients with epilepsy under valproic acid therapy. Medicine (Baltimore) 93:e66

    Article  CAS  Google Scholar 

  103. van der Marck MA, Klok MP, Okun MS, Giladi N, Munneke M, Bloem BR, Falls Task Force NPF (2014) Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson’s disease. Parkinsonism Relat Disord 20:360–369

    Article  PubMed  Google Scholar 

  104. van Doorn C, Gruber-Baldini AL, Zimmerman S, Hebel JR, Port CL, Baumgarten M, Quinn CC, Taler G, May C, Magaziner J et al (2003) Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc 51:1213–1218

    Article  PubMed  Google Scholar 

  105. van Iersel MB, Zuidema SU, Koopmans RT, Verhey FR, Olde Rikkert MG (2005) Antipsychotics for behavioural and psychological problems in elderly people with dementia: a systematic review of adverse events. Drugs Aging 22:845–858

    Article  PubMed  Google Scholar 

  106. Vestergaard P, Rejnmark L, Mosekilde L (2008) Selective serotonin reuptake inhibitors and other antidepressants and risk of fracture. Calcif Tissue Int 82:92–101

    Article  CAS  PubMed  Google Scholar 

  107. Vink D, Aartsen MJ, Schoevers RA (2008) Risk factors for anxiety and depression in the elderly: a review. J Affect Disord 106:29–44

    Article  PubMed  Google Scholar 

  108. Whooley MA, Kip KE, Cauley JA, Ensrud KE, Nevitt MC, Browner WS (1999) Depression, falls, and risk of fracture in older women. study of osteoporotic fractures research group. Arch Intern Med 159:484–490

    Article  CAS  PubMed  Google Scholar 

  109. Williams LJ, Pasco JA, Stuart AL, Jacka FN, Brennan SL, Dobbins AG, Honkanen R, Koivumaa-Honkanen H, Rauma PH, Berk M (2015) Psychiatric disorders, psychotropic medication use and falls among women: an observational study. BMC Psychiatry 15:75; doi:10.1186/s12888-015-0439-4

  110. Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, Marra CA (2009) Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 169:1952–1960

    Article  PubMed  Google Scholar 

  111. Wu Q, Bencaz AF, Hentz JG, Crowell MD (2012) Selective serotonin reuptake inhibitor treatment and risk of fractures: a meta-analysis of cohort and case-control studies. Osteoporos Int 23:365–375

    Article  CAS  PubMed  Google Scholar 

  112. Yirmiya R, Bab I (2009) Major depression is a risk factor for low bone mineral density: a meta-analysis. Biol Psychiatry 66:423–432

    Article  PubMed  Google Scholar 

  113. Yogev-Seligmann G, Hausdorff JM, Giladi N (2008) The role of executive function and attention in gait. Mov Disord 23:329–342

    Article  PubMed  Google Scholar 

  114. Ziere G, Dieleman JP, van der Cammen TJ, Hofman A, Pols HA, Stricker BH (2008) Selective serotonin reuptake inhibiting antidepressants are associated with an increased risk of nonvertebral fractures. J Clin Psychopharmacol 28:411–417

    Article  CAS  PubMed  Google Scholar 

  115. De Groot MH, Van Campen JPCM, Moek MA, Tulner LR, Beijnen JH, Lamoth CJC (2013) The effects of fallrisk-increasing drugs on postural control: A literature review. Drugs and Aging 30(11):901–920

    Google Scholar 

  116. Echt MA, Samelson EJ, Hannan MT, Dufour AB, Berry SD (2013) Psychotropic drug initiation or increased dosage and the acute risk of falls: a prospective cohort study of nursing home residents. BMC Geriatr 13:19

    Google Scholar 

  117. Forester BP, Streeter CC, Berlow YA, Tian H, Wardrop M, Finn CT, et al (2009) Brain lithium levels and effects on cognition and mood in geriatric bipolar disorder: a lithium-7 magnetic resonance spectroscopy study. Am J Geriatr Psychiatry 17(1):13–23

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Andrea Iaboni MD, DPhil, FRCPC

  2. Geriatric Rehabilitation Program, The Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada

    Andrea Iaboni MD, DPhil, FRCPC

  3. Centre for Addiction and Mental Health, Toronto, ON, Canada

    Benoit H. Mulsant MD, FRCPC

Authors
  1. Andrea Iaboni MD, DPhil, FRCPC
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  2. Benoit H. Mulsant MD, FRCPC
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Correspondence to Andrea Iaboni MD, DPhil, FRCPC .

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Editors and Affiliations

  1. University of Ottawa and The Ottawa Hospital, Head, Division of Geriatric Medicine University of Ottawa and The Ottawa Hosp, Montréal, Québec, Canada

    Allen R. Huang

  2. Head, Faculty of Pharmacy Université de Montréal, Université de Montréal, Montréal, Québec, Canada

    Louise Mallet

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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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  • DOI: https://doi.org/10.1007/978-3-319-32304-6_9

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