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Association between antidepressants and falls in Parkinson’s disease

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Abstract

Parkinson’s disease (PD) patients have an increased risk of falls resulting in important social and economical consequences. Risk factors for falls include the use of psychotropic drugs, which are used for the treatment of PD neuropsychiatric symptoms. We aimed to determine the association between psychotropic drug use and falls in a PD cohort. A cross-sectional study from the NPF QII study UF site was conducted. Subjects reported presence and frequency of falls in the prior year. Frequency was scored from 0 (no falls) to 4 (falling daily). Antidepressants, antipsychotics, cognitive enhancers/stimulants, and benzodiazepines were considered psychotropics. Forty percent of the 647 subjects included had a fall in the previous year. Fallers were found to have clinical signs of a more advanced disease. After adjusting for confounding variables, the regression analysis showed that use of antidepressants alone (adjusted OR 2.2, CI 95 % 1.3–3.8, p = 0.04), benzodiazepines alone (adjusted OR 2.0, CI 95 % 1.1–3.5, p = 0.02), and the combination of antidepressants with benzodiazepines (adjusted OR 4.1, CI 95 % 2.0–8.3, p < 0.0001) were independently associated with the presence of falls. When comparing to those not on psychotropics, subjects on antidepressants alone had a significantly higher mean frequency of falls score (1.07 vs. 0.44, p < 0.0001). The use of antidepressants was independently associated with falls in our PD cohort after considering for confounding variables such as age and measures of disease progression. Other factors related to disease progression should be considered before claiming the use of psychotropic drugs as causative.

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Acknowledgments

We would like to acknowledge the support of the National Parkinson Foundation, Tyler’s Hope and the Bachmann-Strauss Foundations. Also we would like to acknowledge the UF Foundation and the UF INFORM database, as well as Amanda Eillers, Charles Jacobson, Holly Fairchild, Leili Shagholi, and Sol de Jesus for helping obtaining data. This manuscript was run through the iThenticate system provided by the University of Florida and the first author takes full responsibility for ensuring originality.

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Authors and Affiliations

  1. Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, 3450 Hull Road, Gainesville, FL, 32607, USA

    Daniel Martinez-Ramirez, Juan C. Giugni, Leonardo Almeida, Roger Walz, Bilal Ahmed, Fiona A. Chai, Valerie Rundle-Gonzalez, Alberto R. Bona, Erin Monari, Aparna Wagle Shukla, Christopher W. Hess & Michael S. Okun

  2. Department of Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA

    Michael S. Okun

  3. Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA

    Chris J. Hass

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  1. Daniel Martinez-Ramirez
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Corresponding author

Correspondence to Daniel Martinez-Ramirez.

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Conflicts of interest

No financial disclosure or conflict of interest concerning the research related to the manuscript.

Funding sources

This work was supported by the National Parkinson Foundation, Tyler’s Hope, Bachmann-Strauss Foundation, University of Florida Foundation, and the UF INFORM database.

Financial disclosure for the previous 12 months

Martinez-Ramirez D, Giugni JC, Almeida L, Ahmed B, Rundle-Gonzalez V, Bona AR, Monari E, Chai FA, Wagle Shukla A, Hess CW, and Hass CJ report no disclosures. Walz R is supported by Brazilian Program Science Without Borders of CNPq. Okun MS, with address 3450 Hull Road, Gainesville, FL 32607, serves as a consultant for the National Parkinson Foundation, and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation.  Dr. Okun has previously received honoraria, but in the past >48 months has received no support from industry.  Dr. Okun has received royalties for publications with Demos, Manson, Amazon, Smashwords, and Cambridge (movement disorders books).  Dr. Okun is an associate editor for New England Journal of Medicine Journal Watch Neurology. Dr. Okun has participated in CME activities on movement disorders (in the last 36) months sponsored by PeerView, Prime, and by Vanderbilt University. The institution and not Dr. Okun receives grants from Medtronic and ANS/St. Jude, and the PI has no financial interest in these grants.  Dr. Okun has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria.

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Martinez-Ramirez, D., Giugni, J., Almeida, L. et al. Association between antidepressants and falls in Parkinson’s disease. J Neurol 263, 76–82 (2016). https://doi.org/10.1007/s00415-015-7947-5

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  • DOI: https://doi.org/10.1007/s00415-015-7947-5

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