Which antidepressant is associated with a higher risk of falls due to orthostatic hypotension in the elderly?

Amitriptyline is an antidepressant that belongs to the tricyclic antidepressant (TCA) class, which is well-known for its anticholinergic effects and propensity to cause sedation. One of the significant side effects associated with amitriptyline and other TCAs is orthostatic hypotension, which can lead to an increased risk of falls, particularly in the elderly population. This is due to the drug's ability to block alpha-1 adrenergic receptors, leading to vasodilation and reduced vascular resistance.

In older adults, who may already be at risk for falls due to issues such as decreased proprioception, comorbidities, or polypharmacy, the added risk of falls from medications that cause orthostatic hypotension becomes a critical safety concern. These factors necessitate careful consideration when prescribing antidepressants to this vulnerable population.

While other antidepressants, such as venlafaxine, can also cause blood pressure changes, especially at higher doses, and bupropion is generally less associated with orthostatic hypotension and escitalopram is considered to have a more favorable side effect profile, amitriptyline's profile makes it particularly concerning in the context of fall risk in