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Are higher antidepressant plasma concentrations associated with fall risk in older antidepressant users?
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  • anouschka Pronk,
  • Eveline van Poelgeest,
  • Lotta Seppala,
  • Kim Ploegmakers,
  • B H Stricker,
  • Karin Swart-Polinder,
  • Suzanne van Dijk,
  • Sadaf Oliai,
  • Lisette de Groot,
  • Natasja M. van Schoor,
  • Ron Mathot,
  • Nathalie van der Velde
anouschka Pronk
Amsterdam UMC Locatie AMC
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Eveline van Poelgeest
Amsterdam UMC Locatie Meibergdreef
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Lotta Seppala
Amsterdam UMC Locatie Meibergdreef
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Kim Ploegmakers
Amsterdam UMC Locatie Meibergdreef
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B H Stricker
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Karin Swart-Polinder
Amsterdam UMC Locatie VUmc
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Suzanne van Dijk
Erasmus University Rotterdam
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Sadaf Oliai
Erasmus University Rotterdam
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Lisette de Groot
Wageningen Universiteit en Researchcentrum
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Natasja M. van Schoor
Amsterdam Public Health Research Institute
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Ron Mathot
Amsterdam UMC - Locatie AMC
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Nathalie van der Velde
Amsterdam UMC Locatie Meibergdreef
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Abstract

Aim Antidepressants are well-established fall-risk increasing drugs(FRIDs) and therefore falls should be considered an important adverse drug event(ADE) of antidepressants. However, not all antidepressant users experience fall incidents and factors associated with increased fall risk among antidepressant users are incompletely understood. Our objective was to explore whether antidepressant plasma concentrations are associated with falls in older antidepressant users. Methods For this study, we included antidepressant users of the multicenter B-PROOF study. Fall incidents were recorded prospectively using fall calendars. Antidepressant plasma concentrations were analyzed by Liquid chromatography-mass spectrometry(LC-MS) at baseline and at 2 years follow-up. The associations between the observed antidepressant concentration, or concentration change over time (delta) and fall risk were assessed using Cox proportional hazard and logistic regression models and adjusted for potential confounders. Results In total 93 selective serotonin reuptake inhibitor(SSRI) and 41 antidepressant(TCA) users were identified. There was a significant association between baseline TCA plasma concentration and fall risk within users (HR 2.50, 95% CI 1.07-5.87, crude model). Adjusted there were no significant associations between concentrations of SSRIs and fall risk. Also, for delta concentrations there was no association with fall risk in users. Conclusion There might be an association between plasma concentrations of TCAs and the risk of falling in older users. However, these results needs to be interpreted with caution considering the small sample size and accompanying limitation of confinement to crude analyses. Therefore, replication in a larger cohort, preferably including adjustment for potential confounders and more frequent measures of plasma concentrations is needed.