Joo Jin H, Lenze Eric J, Mulsant Benoit H, Begley Amy E, Weber Elizabeth M, Stack Jacqueline A, Mazumdar Sati, Reynolds Charles F, Pollock Bruce G
Intervention Research Center for Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA.
J Clin Psychiatry. 2002 Oct;63(10):936-41. doi: 10.4088/jcp.v63n1012.
Prior studies have found that antidepressant medications are associated with an increased risk of falling in elderly persons. However, little is known about the prevention of falls during treatment for depression in elderly persons. This study evaluated the time course and potential risk factors for falls in a treatment protocol for late-life depression to identify specific at-risk periods and risk factors for falls in this population.
One hundred four subjects aged 69 years and over were treated in a protocolized manner using paroxetine and interpersonal psychotherapy. Those who did not respond received augmentation therapy with bupropion, nortriptyline, or lithium. Subjects were assessed at baseline and weekly during treatment; demographic and clinical characteristics of those who experienced a fall during treatment were compared with those who did not fall. Cox proportional hazards models were used to define risk factors for falls in univariate and multivariate models.
During a mean of 21 weeks of treatment, 40 subjects (38%) fell. About half (53%) of the subjects fell during the first 6 weeks of treatment. In the multivariate model, memory impairment and orthostatic changes in blood pressure during treatment were risk factors for falling. Additionally, augmentation with bupropion appeared to be a risk factor for falls in univariate analysis, but this result is preliminary due to the small number of subjects who took bupropion.
Increased monitoring for falls is warranted during the acute treatment of late-life depression. When treating such patients, clinicians should be especially watchful of those with memory impairments or those who develop orthostatic blood pressure changes; orthostatic blood pressure should be measured throughout acute treatment. Additionally, augmenting paroxetine with bupropion may also increase the risk of falls, and this medication combination should be used with caution in elderly patients.
先前的研究发现，抗抑郁药物与老年人跌倒风险增加有关。然而，对于老年抑郁症患者治疗期间跌倒的预防知之甚少。本研究评估了老年抑郁症治疗方案中跌倒的时间进程和潜在风险因素，以确定该人群跌倒的特定风险期和风险因素。
104名69岁及以上的受试者采用帕罗西汀和人际心理治疗进行规范化治疗。无反应者接受安非他酮、去甲替林或锂盐强化治疗。在基线和治疗期间每周对受试者进行评估；将治疗期间发生跌倒的受试者的人口统计学和临床特征与未跌倒者进行比较。使用Cox比例风险模型在单变量和多变量模型中确定跌倒的风险因素。
在平均21周的治疗期间，40名受试者（38%）跌倒。约一半（53%）的受试者在治疗的前6周内跌倒。在多变量模型中，治疗期间的记忆障碍和体位性血压变化是跌倒的风险因素。此外，在单变量分析中，安非他酮强化治疗似乎是跌倒的一个风险因素，但由于服用安非他酮的受试者数量较少，这一结果是初步的。
在老年抑郁症的急性治疗期间，有必要加强对跌倒情况的监测。治疗此类患者时，临床医生应特别留意有记忆障碍或出现体位性血压变化的患者；在整个急性治疗过程中应测量体位性血压。此外，用安非他酮强化帕罗西汀治疗也可能增加跌倒风险，在老年患者中应谨慎使用这种药物组合。
