PsychoTropicalResearch, serotonin and serotonin syndrome research.
Accidents - Falls
Accidents - Falls
Date Created: 02/04/1999 Last Modified: 19/01/2002 Last Checked: 07/01/2003
Accidents involving motor vehicles and those in the (nursing) home may be affected by impairment from (therapeutic) drugs. As yet there is surprisingly little good data available to indicate what differences there are between drugs, despite the moves in various countries to introduce workplace testing for various drugs. Data on road traffic accidents (see 'Accidents RTAs') is not yet good enough to enable us to give clear and confident advice to either patients, or other authorities, concerning most drugs.
This is particularly so because all comparisons have been made between healthy people on vs off the drug; that may be quite different to ill people on vs off drugs. If you think that sounds pedantic read the notes in the references re TCAs vs SSRIs.
It is therefor interesting to examine recent findings concerning the risk of falls in the elderly because they contain lessons about assumptions regarding cause and effect that may be applicable to driving data. In particular there has been a (often unstated) presumption that the sedative and hypotensive effects of TCAs are the cause of falls; the data below suggest falls may be related to the illness more than the treatment. The findings reveal no advantage from using SSRIs (over the TCAs). Indeed they suggest that some TCAs may be better than SSRIs.
This reinforces what I say elsewhere in 'Psychopharmacology update notes':-- it is not logical to lump all the TCAs together when we know that they vary by one hundred-fold in the potency of their sedative (and hypo-tensive) effects. It is still sensible to take account of these differences between TCAs when selecting a drug.
In a prospective cohort study of 7,414 elderly women Whooley et al found no difference in mean bone mineral density (in those with vs without depression) and they also found depression itself was a significant risk factor for fracture even after accounting for medication use. Those with depression had a greater frequency of falls.
Thapa et el found in a large study of 2,428 nursing home residents that there was little difference in rates of falls between those treated with tricyclic antidepressants and those treated with serotonin reuptake inhibitors. Thus, as Nygaard et al suggest, anxiety and depressive states may themselves contribute to falling.
Also (Guttman et al) data reveal that restraint use (in nursing homes) imposes more risk of falls than it prevents.
All text ©Dr Ken Gillman MRC Psych - PsychoTropical Research®
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