Antidepressants Increase Fall Risk

This is a headline that has been all over the internet in the past few weeks. Those of us in the vestibular business have known this for years, so the increased public awareness can only be a good thing. A recent study published in the British Journal of Clinical Pharmacology shows that nursing home residents with dementia are three times more likely to fall if they are also taking a specific type of antidepressant known as SSRI’s (selective serotonin reuptake inhibitors). There has been some evidence in the past that tricyclic antidepressants increased risk of falling, and there has been suspicion that SSRI’s were also a problem. This new and widely distributed study shows a clear connection between SSRI use and falling.

This should not come as a surprise, as balance requires the efficient and harmonious integration of many different senses, muscles, and reflexes that contribute to safe ambulation. What might come as a surprise is the number of people using some type of psychoactive medication. A recent New York Times article reports that 10% of the general population, and 71% of nursing home residents are on some type of psycho-active drug

While I am confident that psychoactive drugs negatively affect balance, I also think it is important to consider alternative or additional factors. Could it be that SSRI’s are used to treat depression, and that it is the depression (not the SSRI) leading to the increased incidence of falling?  Could it be that dementia is the primary risk factor in these patients? The authors of this study made a point of stating that while they found a clear association between SSRI use and falling in nursing home residents with dementia, they could not show a cause and effect relationship. Next week, let’s take a look at what we know about depression, dementia and fall risk.


About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.