Are higher antidepressant plasma concentrations associated with fall risk in older antidepressant users?

A. C. Pronk*, E. P. van Poelgeest, L. J. Seppala, K. J. Ploegmakers, B. H. Stricker, K. M.A. Swart, S. C. van Dijk, S. Oliai Araghi, L. C.P.G.M. de Groot, N. M. van Schoor, R. A.A. Mathôt, N. van der Velde

*Corresponding author for this work

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Purpose: Antidepressants are well-established fall-risk increasing drugs (FRIDs) and therefore falls should be considered an important adverse drug event (ADE) of antidepressants. However, not all antidepressant users experience fall incidents and factors associated with increased fall risk among antidepressant users are incompletely understood. Our objective was to explore whether antidepressant plasma concentrations are associated with falls in older antidepressant users. Methods: For this study, we included antidepressant users of the multicenter B-PROOF study. Fall incidents were recorded prospectively using fall calendars. Antidepressant plasma concentrations were analyzed by Liquid chromatography-mass spectrometry (LC–MS) at baseline and at 2 years follow-up. The associations between the observed antidepressant concentration and fall risk were assessed using Cox proportional hazard and logistic regression models and adjusted for potential confounders. Results: In total 93 selective serotonin reuptake inhibitor (SSRI) and 41 antidepressant (TCA) users were identified. There was a significant association between baseline TCA plasma concentration and fall risk within users (HR 2.50, 95% CI 1.07–5.87, crude model). In the adjusted model, there were no significant associations between concentrations of SSRIs and fall risk. Conclusion: There might be an association between plasma concentrations of TCAs and the risk of falling in older users. However, these results needs to be interpreted with caution considering the small sample size and accompanying limitation of confinement to crude analyses. Therefore, these novel findings need to replicated in a larger cohort, preferably including adjustment for potential confounders and more frequent measures of plasma concentrations is needed.

Original languageEnglish
Pages (from-to)89-97
Number of pages9
JournalEuropean Geriatric Medicine
Issue number1
Publication statusPublished - Feb 2023

Bibliographical note

Funding Information:
This work was supported by the Clementine Brigitta Maria Dalderup fund (project numbers 3021 and 3549, receiver N. van der Velde), which is an Amsterdam University fund ( ). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The initial B-PROOF was funded by the Netherlands Organization for Health Research and Development (ZonMw, Grant 6130.0031), the Hague; unrestricted grant from NZO (Dutch Dairy Association), Zoetermeer; Orthica, Almere; NCHA (Netherlands Consortium Healthy Ageing), Leiden/Rotterdam; Ministry of Economic Affairs, Agriculture and Innovation (project KB-15-004-003), the Hague; Wageningen University, Wageningen; VUmc, Amsterdam; Erasmus Medical Center, Rotterdam; Unilever, Colworth, UK. The sponsors and patients had no role in the design or implementation of the study, data collection, data management, data analysis, data interpretation, or in the preparation, review, or approval of the manuscript.

Publisher Copyright:
© 2023, The Author(s).


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