Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain.
Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid IdiPaz and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.
Maturitas. 2024 Oct;188:108083. doi: 10.1016/j.maturitas.2024.108083. Epub 2024 Jul 27.
Tricyclic antidepressants are effective for managing depression and other disorders. However, they can cause adverse reactions due to their anticholinergic properties, with the risk of such events increasing with age. This study identifies and describes clinical studies that evaluate associations between the use of tricyclic antidepressants and adverse health outcomes (falls, fractures, and mortality) among older people. A systematic search of the literature in English, Spanish, and French was conducted using the electronic databases PubMed, ISI Web of Science, PsycINFO, and Cochrane. The systematic review included a total of 18 studies. The meta-analysis examined the 14 studies that investigated the association between the use of tricyclic antidepressants and the risk of falls and fractures (4 of the 18 studies focused on mortality and so were excluded from the meta-analysis). The odds ratio (OR) was 1.40 (95 % CI = 1.27-1.53, p < 0.001). The Cochran Q test was significant (X = 79.72, p < 0.001), indicating high heterogeneity (I = 84.9 %). An additional meta-analysis was conducted on studies reporting hazard ratios (HRs), yielding an HR of 1.21 (95 % CI = 0.93-1.58, p = 0.16). Meta-regression analysis indicated that the years of follow-up could have a significant effect on the association studied (p = 0.008). In conclusion, enhancing our understanding of the use of antidepressants and the associated risk of adverse events in older adults will enable the identification of the most appropriate type of antidepressant for each clinical situation.
三环类抗抑郁药对治疗抑郁症和其他疾病很有效。但是，由于其抗胆碱能特性，它们可能会引起不良反应，而且随着年龄的增长，此类事件的风险会增加。本研究旨在确定并描述评估三环类抗抑郁药在老年人中的使用与不良健康结果（跌倒、骨折和死亡）之间相关性的临床研究。通过电子数据库 PubMed、ISI Web of Science、PsycINFO 和 Cochrane 以英文、西班牙语和法语对文献进行了系统检索。系统综述共纳入了 18 项研究。Meta 分析检查了 14 项研究，这些研究调查了三环类抗抑郁药的使用与跌倒和骨折风险之间的关系（18 项研究中有 4 项研究侧重于死亡率，因此被排除在 Meta 分析之外）。比值比（OR）为 1.40（95%可信区间=1.27-1.53，p<0.001）。Cochran Q 检验具有统计学意义（X=79.72，p<0.001），表明存在高度异质性（I=84.9%）。对报告危险比（HR）的研究进行了额外的 Meta 分析，得出的 HR 为 1.21（95%可信区间=0.93-1.58，p=0.16）。Meta 回归分析表明，随访年限可能对所研究的关联有显著影响（p=0.008）。总之，深入了解老年人使用抗抑郁药与不良事件风险之间的关系，将有助于确定每种临床情况下最适合的抗抑郁药类型。
