00:00This is the world's largest review looking at antidepressant use for pain in older people
00:07and the findings were very concerning.
00:09So we found that antidepressants are being prescribed more for pain than for depression in older people
00:16and the evidence around this is very unclear.
00:19There's a lot of harms associated with antidepressant use in this population
00:24and so it's very concerning that a lot of older people are getting this for pain.
00:29Is there a correlation between pain and depression?
00:32Say, can chronic pain lead to depression?
00:34So is it a way of treating the two symptoms with the one pill?
00:38Well, I think it wouldn't be wise to treat both symptoms with the one pill
00:43simply because antidepressants have a lot of adverse effects.
00:47There's evidence in younger people, however we cannot use it for older people
00:52because as we age our bodies change, medicines work differently
00:57so the evidence needs to be there that these medicines actually work for the conditions in older people.
01:03So what are some of the side effects experienced from taking antidepressants when you are above the age of 65?
01:09Sure, so it can lead to a lot of dizziness, sedation, which can lead to falls
01:15and we all know falls can be detrimental in this population leading to injuries and hospitalisation.
01:22Can this increase the medication burden for older patients who are taking multiple prescriptions?
01:28They may be taking the antidepressants to counteract the pain
01:32or they may now need to take something to counteract the dizziness they may be experiencing.
01:37Sure, so older people have other morbidities or diseases
01:42and some of them have multiple diseases and they take many medicines
01:47so adding another medicine for pain increases their medication burden we say
01:52and that leads to adherence issues often when you have too many pills to take you forget
01:58and it can lead to interaction between the drugs which can again cause very harmful effects in this population.
02:04So what do you suggest could be done in the future?
02:08Say coming off antidepressants is quite a complex scenario, what can be done?
02:13Well the first thing is if anyone's taking antidepressants not to stop it abruptly
02:18because withdrawal can have again very adverse events
02:23so have a check with your GP, your clinician if you really need this medicine for pain
02:28and you can get tapered off so come off it quite slowly so that it doesn't affect you adversely.
02:34Other therapies that can be used and have been proven are physical therapy or cognitive behavioural therapy
02:41so these are non-drug treatments which are quite friendly in older people.
02:44There have been trials that have shown that these are quite effective particularly for chronic pain.
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