Selective serotonin-reuptake inhibitor antidepressants increase the risk of falls and hip fractures in elderly people by inhibiting cardiovascular ion channels

Surprising results from recently published retrospective studies show that the use of new selective serotonin-reuptake inhibitor antidepressants (SSRI s), similarly to the older tricyclic antidepressants (TCAs), increases the risk of falls and hip fractures among elderly people. The mechanism whereby antidepressants increase this risk is complex and may include orthostatic hypotension, arrhythmias, sedation and confusion. The increased risk of falls and hip fractures with the use of TCAs is not surpr ising considering their well-known cardiovascular, anticholinergic and anti histaminergic side-effects. But the increased risk of falls with SSRIs is h ighly unexpected since these drugs are believed to be free from the disadva ntages of TCAs. We hypothesized that the new SSRI antidepressants may also have cardiovascu lar effects similarly to the older TCA compounds, which may be an explanati on for the increased rate of falls and hip fractures. The experimental and clinical evidence in support of this hypothesis are discussed. (C) 2001 Har court Publishers Ltd.