Antidepressants, Alzheimer’s and Brain Injuries: making bad worse

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What we knew:lights-1088141__340

  • Use of antidepressants with Alzheimer’s patients increases the risk for falls and hip fractures
  • There is a protein found in the brain cells of persons with dementia and brain injuries that causes the Axon in the cell (electronic message transmitter) to swell and shut down. This protein is absent from normal cells. Elimination of the protein can cause the axon to start functioning again. (References are in previous blog.)

What the University of Eastern Finland has added to what we know:

  • Use of antidepressants with Alzheimer’s patients results in an increased incidence of traumatic brain injuries among these patients

The mechanism for the injury is probably falling. With slower mental processing and thus slower reflexes, these patients are less able to protect themselves when falling. That means a higher rate of concussions.

This ties back to another previous post on this blog — “deprescribing”. Drugs may have a value in one stage of a person’s life and be counterproductive at another stage. Doctors know how to prescribe drugs, but there are few protocols (apart for drug interactions) regarding when to stop taking a drug.  There is a group in Canada developing guidelines for deprescription, and while NIH has published articles on the topic, I’m not aware of any similar projects to develop guidelines in the US. Some US physicians appear to be doing this on an ad hoc basis.

I suspect deprescription is not a popular topic among pharmaceutical executives, but it needs to be addressed. Continuation of unnecessary medication is just one of many factors that bloats medical costs in the US — and why spending level no longer indicates quality of care. Unnecessary medication poses risks to some patients.


Sources:

  1. Heidi Taipale, Marjaana Koponen, Antti Tanskanen, Piia Lavikainen, Reijo Sund, Jari Tiihonen, Sirpa Hartikainen, Anna-Maija Tolppanen. Risk of head and traumatic brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease: a nationwide matched cohort study. Alzheimer’s Research & Therapy, 2017; 9 (1) DOI: 10.1186/s13195-017-0285-3
  2. University of Eastern Finland. “Antidepressant use increases risk of head injuries among persons with Alzheimer’s disease.” ScienceDaily. ScienceDaily, 9 August 2017. <www.sciencedaily.com/releases/2017/08/170809073627.htm>.
  3. Gurusamy Sivagnanam, “Deprescription: The prescription metabolism,”
    J Pharmacol Pharmacother. 2016 Jul-Sep; 7(3): 133–137.
    doi:  10.4103/0976-500X.189680
  4. http://deprescribing.org/
  5. http://www.drjohnm.org/2014/10/to-deprescribe-adding-a-new-verb-to-the-language-of-doctoring/
  6. Joaquín Hortal Carmon, IvánAguilar Cruz, FranciscoParrilla Ruiz, “A prudent deprescription model,” Science Direct, Medicina Clínica, Volume 144, Issue 8, 20 April 2015, Pages 362-369.

 

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2 thoughts on “Antidepressants, Alzheimer’s and Brain Injuries: making bad worse

  1. Vic Crain the the risk of falls among the elderly is quite high. At our hospital in Massachusetts, 20-40 percent have fallen resulting in them being admitted to us for rehabilitation. We take great steps to prevent falls here in the hospital. That said, many medications create changes in balance and can add to risk of falls. This must be avoided when medication is first prescribed. The Finnish study brings to life the impact of SSRI antidepressant medication on patients with Alzheimer’s Disease and the risk they face with any changes in medication. Yet it is known that the use of antidepressant medication may enhance the life experience of those suffering with dementia. In a statement paper, the Academy of Internal Medicine has said the key to long life in balance, core strength and having relationships. Thanks for your interesting post and keeping this topic in the news feed. Michael Sefton, Ph.D.

    Liked by 2 people

    • Michael, thank you for your comment. I totally understand and agree with the points you are making.

      To mean the real issue is medication management. Think of the metaphor of flying an airplane. There are delicate controls, and slight variations in the environment can affect their performance. If the patient is the plane, whose at the controls? The doc who sees the patient for a cursory visit once every month or two? (My experience.) The patient who doesn’t understand what the drugs are supposed to do? The pharmacist? No one?

      Medication can be very valuable, but there are circumstances in which it can do harm or simply becomes irrelevant. Under the US care model, who’s going to observe and react to changes?

      Like

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