Selective serotonin reuptake inhibitors (SSRI) may be outliving its welcome as a drug of choice for depression, anxiety disorder and other personality disorders. The drug has always been widely controversial to researchers who often argue that patients with mild or moderate cases have had little if any improvement from the use of the drug. Now reports suggest that selective serotonin reuptake inhibitor increases a patient’s risk of falling and causing injury when given to nursing home residents suffering from dementia. Additionally, research conducted recently by the Alzheimer’s Society has revealed that Selective Serotonin Reuptake Inhibitors are of no benefit for dementia patients living in care homes.
The study reveals that the risk is dose-dependent, with those using average doses having 3 times the risk compared with nonusers, the authors, led by Carolyn S. Sterke, MSc, from Erasmus University Medical Center, Rotterdam, the Netherlands.
“Even at low doses, SSRIs are associated with increased risk of an injurious fall in nursing home residents with dementia,” the authors write.
Professor Clive Ballard, the Director of Research at the Alzheimer’s Society said, “Two thirds of care home residents have dementia so it is worrying that a common antidepressant, Selective Serotonin Reuptake Inhibitors (SSRIs), is causing increased risk to people with the condition”.
And it’s not just an injury doctors are afraid of; quite often the falls could lead to death.
Professor Ballard further affirmed that they would be extending the research so they could get to know about other safer options for dementia patients.
They want to find an alternative early so that they could start with its prescriptions as about two-third elderly people living in care homes are suffering dementia. So they have to make sure that they remain safe there.
Rotterdam study drew the same conclusions in their research. In their investigation they found that a person taking SSRIs falls about 248 times in a period of two years. During the period, more than 583 elderly people suffered severe injuries such as fractures, sprains, bruises, and even death to similar mishaps. As per them, there is direct association between SSRIs and falls.
So now, it has become more important to find another safer option for dementia people who live in care homes. It is reported that there are chances for the research team to join Alzheimer’s Society in their further research.
The use of an SSRI with a hypnotic or sedative increases the risk even further, they add.
The study is published online January 18 in the British Journal of Clinical Pharmacology.
Rotterdam found that head injury occurs when an outside force hits the head hard enough to cause the brain to move violently within the skull. This force can cause shaking, twisting, bruising (contusion), or sudden change in the movement of the brain (concussion).
In some cases, the skull can break. If the skull is not broken, the injury is a closed Head injury. If the skull is broken, the injury is an open Head injury. In either case, the violent jarring of the brain damages brain tissue and tears nerves, blood vessels, and membranes. The severity of this damage depends on the location and force of the blow to the head. When brain tissue is damaged like this it rarely is able to function normally.
The brain has many different functions in the body, and any of them can be disrupted by this damage.
Not all brain damage is permanent. Like all body organs, the brain can heal to a certain extent. But even this healing may not bring the brain’s function back to what it was before the injury.
“These are frail, elderly patients,” Josepha A. Cheong, MD, professor of psychiatry at the University of Florida College of Medicine, Gainesville, Florida, who was not involved in the research, told Medscape Medical News.
“This study is a reminder that the elderly with dementia are prone to many serious complications, such as falls, and are certainly more sensitive to polypharmacy. They are more likely to be on multiple medications. This is likely to potentiate any adverse drug reactions or side effects, including increased sedation, which can certainly predispose a patient to a fall,” she said.
The study investigators analyzed daily drug use and daily falls over a 2-year period, from January 1, 2006, to January 1, 2008, in 248 nursing home residents with dementia. Their mean age of the participants was 82 years.
The investigators extracted the use and dose of SSRIs and other drugs known to increase the risk of falls, including antipsychotics, anxiolytics, hypnotics, sedatives, antidiabetic drugs, beta-blocker eyedrops, cardiovascular drugs, analgesics, anticholinergics, antihistamines, and antivertigo drugs, from the prescription database in the medical records.
The most common SSRI was citalopram, followed by paroxetine, sertraline, and fluvoxamine. The tricyclic antidepressants amitriptyline and nortriptyline were also used; other antidepressants included trazodone and mirtazapine.
The fact that these drugs make patients more lethargic and lead a catastrophic fall is one thing, but the possibility that they may not be even helping these patients arguably borders of criminality.
Though brain health changes can also result from poor diet, lack of exercise or brain stimulation, and not drinking enough water every day, Brain function may change as a result of stress, medicines, and many other reasons researchers are now wondering, why compound these consequences with the effects consistent with the use of selective serotonin reuptake inhibitors .
Professor Ballard is currently pushing the profession to seriously consider prevention as well as the immediate termination of selective serotonin reuptake inhibitors.
Ballard suggests that patients may need some therapies such as medicines to stabilize a chronic health condition that can affect brain cell health.
Some of the conditions affecting the brain are: High Blood Pressure, very low blood pressure, uneven heart beat, or a heart beat that is too fast or too slow. Other conditions such as diabetes affect arteries and veins and thus may limit a good flow of blood throughout the brain (and body). Better control of the diabetes may result in less damage to the health of the blood vessels, less damage to blood flow, and less damage to brain cells.
In some cases of progressive dementia such as Alzheimer’s disease, the doctor may offer some recommendations including some medicines that may improve or boost brain cell function.
When a person acts quickly without thinking of consequences or when a person acts quickly without weighing possible negative results, such spontaneous actions may end up with actions that show a lack of good judgment. An example of poor judgment is when a diabetic eats too many sweets and ignores the predictable consequences of having a bad reaction. Talking about private family matters with a stranger may lead to unpleasant responses from the stranger. Discussing intimate feelings with a stranger or touching the stranger inappropriately may lead to unpleasant reactions such as a call for help from a law enforcement officer.
While preventative step need to be immediately adopted in our society, the use of selective serotonin reuptake inhibitors equally needs to incorporate these new finding so that doctors that prescribe them can be better informed about the high risk of their continued use.