Psychotropic drugs

Abstract

Available evidence suggests that antidepressants, antipsychotics, lithium, and antiepileptic drugs can increase the risks for falls and fractures in older adults. However, the relationship between falls and psychotropic medications is complex because the mental disorders treated with these psychotropic medications and their comorbidities are themselves significant and independent risk factors for falls. Thus, fall risk by itself is not a contraindication for the use of psychotropic medications in an older frail patient. Nevertheless, clinicians need to prescribe these medications judiciously and to follow principles of conservative prescribing to minimize the risk for falls. While some psychotropic medications may have a direct effect on balance, most falls and fractures are related to other side effects, in particular, orthostatic change in blood pressure, pro-arrhythmogenic effects, extrapyramidal symptoms (including Parkinsonism and akathisia), sedation, and cognitive impairment. Thus, careful selection of specific medications based on their differential side effect profile and monitoring of adverse effects is mandatory. Close monitoring is particularly important during the first few days or weeks after starting a new psychotropic medication or after a dose increase.