Antidepressants prescribed for pain in older adults despite weak evidence of effectiveness

College of Sydney analysis has discovered individuals over 65 are being prescribed antidepressants as ache remedy primarily based on worldwide pointers that use restricted proof. The paper is printed within the British Journal of Medical Pharmacology.

The research discovered that within the final 40 years, there have been solely 15 trials globally specializing in the good thing about antidepressants for ache in older individuals. This research fills a much-needed hole in analysis by bringing collectively the data from these trials to take a look at the efficacy and harms of antidepressants for acute and persistent non-cancer ache in these over 65-years previous.

It finds an absence of proof to tell the usage of antidepressants for many ache situations in older adults, and urges prescribing and remedy practices that contemplate the distinctive wants and dangers of older adults.

Lead writer Dr. Sujita Narayan, a Analysis Fellow on the College’s Institute for Musculoskeletal Well being mentioned worldwide pointers recommending antidepressants for persistent ache are closely primarily based on research that both exclude older adults or embrace solely a small variety of them.

Well being professionals use these as a reference level when treating older sufferers with situations inflicting persistent ache, resembling osteoarthritis.

“If I’m a busy clinician and need to take a look at the rules for fast reference, I’ll in all probability have time to take a look at solely the important thing factors relating to administration of persistent ache, a few of which advise the usage of antidepressants,” mentioned Dr. Narayan, from the School of Drugs and Well being.

Senior writer Affiliate Professor Christina Abdel Shaheed from the College’s Faculty of Public Well being and the Institute for Musculoskeletal Well being emphasised no trials examined the rising use of antidepressants for acute ache resembling that skilled by these with shingles or muscular ache.

“These medicines are being prescribed to treatment sufferers’ ache, regardless of the shortage of proof to adequately inform their use,” Affiliate Professor Abdel Shaheed mentioned. “Nevertheless, harms of antidepressant use in older persons are effectively documented.”

In relation to hurt, the research discovered individuals taking antidepressants skilled extra destructive results, like falling, feeling dizzy, and getting injured, judged in opposition to appropriate comparability teams.

These hostile results noticed extra individuals within the antidepressant group cease taking their remedy than these in placebo teams or teams taking different medicine for ache administration.

“Withdrawal from antidepressants may be as unhealthy as withdrawal from opioids. I might suggest that anybody contemplating discontinuing their remedy to not cease taking their antidepressants instantly, however to seek the advice of with their clinician and devise a tapering plan, as vital,” Dr. Narayan.

The research discovered one exception. Researchers discovered the SNRI duloxetine was in a position to relieve knee osteoarthritis ache in older adults throughout the intermediate time period, however not short-term or long run.

“There was greater high quality proof on its efficacy for persistent ache associated to knee osteoarthritis. This was primarily based on utilizing it for a interval of roughly two to 4 months. It wasn’t vital within the speedy time period, if used for as much as two weeks, and no knowledge was out there to be used past a 12-month interval.

“For clinicians and sufferers who may be utilizing or contemplating duloxetine for knee osteoarthritis, the message is evident: advantages could also be seen with slightly persistence, however the results could also be small and should be weighed up in opposition to the chance,” mentioned Dr. Narayan.

Present proof on antidepressant efficacy and security in older individuals comes principally from small trials. Disclosed trade funded trials with fewer than 100 contributors spotlight the necessity to replace pointers and rethink the medical apply of prescribing antidepressants for ache in older adults, the analysis discovered.

The research helps pointers on the administration of persistent non-cancer ache in older individuals recommending a multidimensional method utilizing non-pharmacological methods, resembling bodily train and cognitive conduct remedy primarily based on trials accomplished particularly in older individuals.

“The important thing level is that we should not depend on findings from research with youthful individuals and apply them to older adults as a result of they’re totally different, older individuals’s our bodies bear adjustments that alter how they reply to medicines. This could result in totally different results in older individuals in comparison with youthful individuals,” mentioned Dr. Narayan.