H ere’s a worrisome new research finding: Several commonly prescribed medications seem to make elderly patients more vulnerable to dangerous falls, including antidepressants.

Researchers at the University of British Columbia (Vancouver) looked at 22 studies involving 79,081 people over the age of 60 to see whether different types of medications may be associated with falls, which -- as you know, because I’ve written about it before -- is a leading precursor to death among the elderly and therefore is a major concern. They studied nine classes of medicine commonly prescribed for this age group and, after adjusting for factors such as age, sex, cognitive problems and other health problems, found that three classes of drugs were significantly associated with falling.

The two strongest associations involved sedatives and benzodiazepines (such as Ativan, Xanax and Klonopin to treat anxiety or insomnia) -- no surprise, since these are well known for causing sleepiness. Nearly as bad, researchers found, was the association between falling and antidepressants -- these widely prescribed drugs were associated with a 36% increased risk.

Balancing Risks and Benefits

To learn more, I called an expert on balance and the causes of falling, otolaryngologist Yuri Agrawal, MD, at Johns Hopkins University School of Medicine. She told me that many antidepressant drugs manipulate the neurotransmitter serotonin to help regulate mood and that serotonin is also involved with healthy cognition, leading to confusion that could be a factor in a fall. Another factor -- antidepressants are known to cause dizziness.

This study provides further evidence of why it is so important to measure risk versus benefit before deciding on a particular type of treatment, Dr. Agrawal pointed out. She says that while many older adults continue to be robust, others are frailer and have less reserve when it comes to adapting to drug side effects. Doctors and patients should weigh the hoped for benefit against the possible negative impact of any drugs, including antidepressants. It may be better to consider nonpharmaceutical therapies, such as cognitive behavior therapy or psychotherapy for emotional issues -- in other words, methods that can be successful but do not carry the worrisome side effects of drugs.