A British study regarding the use of SSRIs (selective serotonin reuptake inhibitors) for nursing home residents has shown an association between the use of SSRIs and an increased risk of falls causing injuries in nursing homes, with the risk increasing as the dose is increased. The study also showed that when SSRIs are used along with a hypnotic or sedative in nursing home patients, the risk of injurious falls is even greater.
What Are SSRIs And How Do They Work?
SSRIs are the most commonly prescribed medications (antidepressants) used to treat depression. They work by balancing chemicals (neurotransmitters such as serotonin, norepinephrine, and dopamine) in the brain that control mood and emotional responses. SSRIs include Fluoxetine (Prozac), Citalopram (Celexa), Sertraline (Zoloft), Paroxetine (Paxil), and Escitalopram (Lexapro). SSRIs are popular because they do not cause as many side effects as older classes of antidepressants such as tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs).
The most common side effects associated with SSRIs include headache (which usually resolves within a few days), nausea (which usually resolves within a few days), sleeplessness or drowsiness (which may happen during the first few weeks but then goes away), agitation, and sexual problems (which can affect both men and women and may include reduced sex drive, and problems having and enjoying sex).
The Association Between Fall Risk And The Use Of SSRIs In Nursing Home Residents
The British study defined a “fall” as unintentionally coming to rest on the ground or any other lower level. “Injurious falls” are falls that result in fractures, grazes, open wounds, sprains, bruises, and swelling. Statistics indicate that one-third of falls in nursing homes result in injuries. Nursing home residents who have dementia average more than 2 falls per bed per year.
Patients using SSRIs have been shown to be at an increased risk of falling. Many nursing home residents who have dementia are often prescribed SSRIs to treat their depression. Until recently, the association between the dosage of SSRIs and the increased risk of falling among nursing home patients with dementia was not quantified.
In the British study, 248 nursing home residents with dementia were studied with regard to their daily drug use and falls between January 1, 2006 and January 1, 2008. The study found that the risk of injurious fall for nursing home residents who were taking SSRIs was 31% at 0.25 of the defined daily dose (the average of a dosage of a drug taken by adults for the main indication as indicated by the World Health Organization), 73% at 0.50 of the defined daily dose, and 198% at 1.0 of the defined daily dose.
The British study’s conclusion was, “Even at low doses, SSRIs are associated with an increased risk of an injurious fall in nursing home residents with dementia. Higher dosages, which were most prevalent in our study population, increased the risk further, with a threefold risk at 1.0 DDD [defined daily dose]. The use of a SSRI in combination with a hypnotic or sedative further increased the risk. The results of this study lend support to the consideration that new treatment protocols might be needed that take into account the dose-response relationship between SSRIs and injurious falls.”
If you or a loved one were injured as a result of a fall in a nursing home or suffered injuries or death as a result of nursing home abuse or nursing home neglect, the advice from a local medical malpractice attorney (nursing home attorney) is essential to learning about your rights in the matter.
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