Antidepressant use nearly doubles the risk of hip fracture among community-dwelling persons with Alzheimer’s disease, according to a new study from the University of Eastern Finland. The increased risk was highest at the beginning of antidepressant use and remained elevated even 4 years later. The findings were published in the International Journal of Geriatric Psychiatry.

For each person with Alzheimer’s disease, two controls without the disease were matched by age and sex. Antidepressant use was associated with two times higher risk of hip fracture among controls. However, the relative number of hip fractures was higher among persons with Alzheimer’s disease compared to controls.

The increased risk was associated with all of the most frequently used antidepressant groups, which were selective serotonin reuptake inhibitors (SSRI drugs), mirtazapine and selective noradrenaline reuptake inhibitors (SNRI drugs). The association between antidepressant use and the increased risk of hip fracture persisted even after adjusting the results for use of other medication increasing the risk of fall, osteoporosis, socioeconomic status, history of psychiatric diseases, and chronic diseases increasing the risk of fall or fracture.

Antidepressants are used not only for the treatment of depression, but also for the treatment of chronic pain and behavioral and psychological symptoms of dementia, including insomnia, anxiety and agitation. If antidepressant use is necessary, researchers recommend that the medication and its necessity be monitored regularly. In addition, other risk factors for falling should be carefully considered during the antidepressant treatment.

The study was based on the register-based MEDALZ cohort comprising data on all community-dwelling persons diagnosed with Alzheimer’s disease in Finland between 2005-2011, and their matched controls. The study population included 50,491 persons with and 100,982 persons without the disease. The follow-up was 4 years from the date of Alzheimer’s disease diagnosis or a corresponding date for controls. The mean age of the study population was 80 years.

Effexor, introduced in 1993, was the first serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant, as distinguished from the more common selective serotonin reuptake inhibitors (SSRIs). The FDA approved the drug for treatment of anxiety and depression, and by 2007 it was the sixth-most-prescribed antidepressant in the U.S., with 17.2 million prescriptions written annually. Wyeth Pharmaceuticals, the drug’s manufacturer, was acquired by Pfizer in 2009. A generic version of the drug, venlafaxine, was approved for sale in 2010.

Studies have linked Effexor to many side effects, ranging from relatively mild effects such as weight gain and fatigue to serious risks such as suicide ideation and birth injuries, when the medication is used by pregnant women.

Birth injuries linked to Effexor include spina bifida, atrial or ventricular septal defects, club foot, heart murmurs and persistent pulmonary hypertension of the newborn (PPHN). The drug has also been linked to spontaneous miscarriage when used by pregnant women.

Such injuries have led to a number of lawsuits. The first lawsuit over birth injuries allegedly caused by ingesting Effexor was filed in February 2012, with two more lawsuits following the same year. The first lawsuit was filed by a woman who claimed that she ingested Effexor while pregnant and that this caused a fatal heart defect in her daughter. Her daughter was born in February 2010 with a malformed aorta, among other defects. The child died soon after birth. According to the lawsuit, the drug’s manufacturer knew or should have known of the risks and failed to warn consumers.

Bob Briskman is a Chicago malpractice attorney with Briskman Briskman & Greenberg. To learn more call 1.877.595.4878 or visit http://www.briskmanandbriskman.com/.