People over the age of 65 are being prescribed antidepressants to treat pain, despite weak evidence showing the drugs work. Researchers say trials of antidepressant drugs and pain relief fail to take into account the implications for older people, who are vulnerable to side effects and other harms.
Category
📺
TVTranscript
00:00This is the world's largest review looking at antidepressant use for pain in older people
00:07and the findings were very concerning.
00:09So we found that antidepressants are being prescribed more for pain than for depression in older people
00:16and the evidence around this is very unclear.
00:19There's a lot of harms associated with antidepressant use in this population
00:24and so it's very concerning that a lot of older people are getting this for pain.
00:29Is there a correlation between pain and depression?
00:32Say, can chronic pain lead to depression?
00:34So is it a way of treating the two symptoms with the one pill?
00:38Well, I think it wouldn't be wise to treat both symptoms with the one pill
00:43simply because antidepressants have a lot of adverse effects.
00:47There's evidence in younger people, however we cannot use it for older people
00:52because as we age our bodies change, medicines work differently
00:57so the evidence needs to be there that these medicines actually work for the conditions in older people.
01:03So what are some of the side effects experienced from taking antidepressants when you are above the age of 65?
01:09Sure, so it can lead to a lot of dizziness, sedation, which can lead to falls
01:15and we all know falls can be detrimental in this population leading to injuries and hospitalisation.
01:22Can this increase the medication burden for older patients who are taking multiple prescriptions?
01:28They may be taking the antidepressants to counteract the pain
01:32or they may now need to take something to counteract the dizziness they may be experiencing.
01:37Sure, so older people have other morbidities or diseases
01:42and some of them have multiple diseases and they take many medicines
01:47so adding another medicine for pain increases their medication burden we say
01:52and that leads to adherence issues often when you have too many pills to take you forget
01:58and it can lead to interaction between the drugs which can again cause very harmful effects in this population.
02:04So what do you suggest could be done in the future?
02:08Say coming off antidepressants is quite a complex scenario, what can be done?
02:13Well the first thing is if anyone's taking antidepressants not to stop it abruptly
02:18because withdrawal can have again very adverse events
02:23so have a check with your GP, your clinician if you really need this medicine for pain
02:28and you can get tapered off so come off it quite slowly so that it doesn't affect you adversely.
02:34Other therapies that can be used and have been proven are physical therapy or cognitive behavioural therapy
02:41so these are non-drug treatments which are quite friendly in older people.
02:44There have been trials that have shown that these are quite effective particularly for chronic pain.