Abstract：
Tricyclic antidepressants are effective for managing depression and other disorders. However, they can cause adverse reactions due to their anticholinergic properties, with the risk of such events increasing with age. This study identifies and describes clinical studies that evaluate associations between the use of tricyclic antidepressants and adverse health outcomes (falls, fractures, and mortality) among older people. A systematic search of the literature in English, Spanish, and French was conducted using the electronic databases PubMed, ISI Web of Science, PsycINFO, and Cochrane. The systematic review included a total of 18 studies. The meta-analysis examined the 14 studies that investigated the association between the use of tricyclic antidepressants and the risk of falls and fractures (4 of the 18 studies focused on mortality and so were excluded from the meta-analysis). The odds ratio (OR) was 1.40 (95 % CI = 1.27-1.53, p < 0.001). The Cochran Q test was significant (X2 = 79.72, p < 0.001), indicating high heterogeneity (I2 = 84.9 %). An additional meta-analysis was conducted on studies reporting hazard ratios (HRs), yielding an HR of 1.21 (95 % CI = 0.93-1.58, p = 0.16). Meta-regression analysis indicated that the years of follow-up could have a significant effect on the association studied (p = 0.008). In conclusion, enhancing our understanding of the use of antidepressants and the associated risk of adverse events in older adults will enable the identification of the most appropriate type of antidepressant for each clinical situation.
摘要：
三环抗抑郁药可有效控制抑郁症和其他疾病。然而,由于它们的抗胆碱能特性，它们会引起不良反应，这类事件的风险随着年龄的增长而增加。本研究确定并描述了评估三环抗抑郁药使用与不良健康结果之间关联的临床研究（跌倒，骨折,和死亡率)在老年人中。对英语文献的系统搜索，西班牙语,法语是使用电子数据库PubMed进行的，ISIWebofScience,PsycINFO,还有Cochrane.系统评价共纳入18项研究。荟萃分析检查了14项研究，这些研究调查了三环抗抑郁药的使用与跌倒和骨折风险之间的关系（18项研究中有4项关注死亡率，因此被排除在荟萃分析之外）。比值比（OR）为1.40（95％CI=1.27-1.53，p<0.001）。CochranQ检验显著(X2=79.72,p<0.001),表明高度异质性(I2=84.9%)。对报告风险比(HRs)的研究进行了额外的荟萃分析，HR为1.21(95%CI=0.93-1.58，p=0.16)。荟萃回归分析表明，随访年限对所研究的关联有显著影响(p=0.008)。总之,加强我们对老年人抗抑郁药的使用和相关不良事件风险的了解,将有助于确定每种临床情况下最合适的抗抑郁药类型.
