Are Older People More Likely to Fall on Antidepressants and Antianxiety Drugs?

Older people may be at particular risk for falls and fractures when they take many medications. Let’s be honest, when people get past a certain age they may be a little less steady in general. Add multiple medications to the mix and you have a recipe for disaster. Many doctors do their best to “fix” something, whether it’s hypertension, anxiety, depression or insomnia. But the drugs that are prescribed can make some people unsteady on their feet. Research has revealed that older individuals may be more likely to fall on antidepressants, which could cause serious fractures. Other drugs that could pose a risk include benzodiazepines for anxiety or insomnia.

We recently received this question from a reader of our syndicated newspaper column:

Q. I occasionally take 0.25 mg Xanax for sleep. I have not noticed any side effects, but I read that it could cause falls. Would this low dose make me fall?

A. It is good that you are using alprazolam (Xanax) only occasionally. It rapidly loses effectiveness if it is taken every night (Journal of Clinical Pharmacology, July 1987).

In addition, some people can become habituated to it fairly quickly. As a result, it would not be our first choice of treatment. We suspect that even a low dose like yours might make you less steady if you get up during the night.

There are many other approaches to overcoming insomnia, and we discuss them in our eGuide to Getting a Good Night’s Sleep. You can find this online resource under the Health eGuides tab.

Why Are Falls So Dangerous?

A recent review of falls in older people (JAMA, Aug. 8, 2025) offered some sobering statistics:

“In 2023, more than 41 000 individuals older than 65 years died from falls. Among older adults, the number of deaths from falls is more than from breast or prostate cancer and is more than from car crashes, drug overdoses, and all other unintentional injuries combined. More importantly, the mortality rate for falls among older adults in the US has more than tripled during the past 30 years. In contrast, death rates due to falls decreased during the past 30 years in other high-income countries.”

Be honest please. When was the last time a healthcare professional tested you for balance? Sometimes a physical therapist or a health coach will do this. But I fear that it is not part of the standard physical exam for people over 65 years of age.

Please take a moment at the end of this article to tell us if your your primary care provider has 1) tested you for dizziness or fall susceptibility or 2) asked whether your medicine makes you dizzy or vulnerable to a fall.

Could You Fall on Antidepressants?

Back in 2012, experts added SSRI and SNRI type drugs such as fluoxetine (Prozac) and venlafaxine (Effexor) to the “Beers list,” a list of drugs often inappropriate for older adults. They flagged these medications to be used only with caution, as they may upset electrolyte balance. Now research suggests that older individuals may be more likely to fall on antidepressants, potentially breaking a bone. A broken hip can be catastrophic for an older person.

Are Seniors More Likely to Fall on Antidepressants?

Researchers examined data from the Prescribed Drugs Register of Sweden’s National Board of Health and Welfare (Brännström et al, JAMA Psychiatry, online Jan. 2, 2018). More than 200,000 people aged 65 and over who were taking antidepressants were matched to other people of a similar age and sex not taking such medicines. The investigators analyzed 408,144 health records in total.

In this analysis, older people on antidepressants had twice as many hip fractures as those serving as controls. The link was a little confusing, since there was no dose-response curve. (In other words, people taking higher doses were not at higher risk.)  Also, the likelihood of a hip fracture was highest just before the antidepressant was prescribed.

Perhaps depression itself contributes to unsteadiness. On the other hand, someone who is hospitalized with a broken hip may possibly be recognized as depressed. This study does not tell us why older people appear more likely to fall on antidepressants.

The Take-Away from Sweden:

The authors point out that evidence for benefit from antidepressant use in this population is limited. They call for treatment studies to clarify the exact risk of fractures associated with antidepressants leading to falls among seniors.

Other Studies Showing a Link Between Medications and Hip Fracture:

This is not the first research to show that older adults may be more likely to break their hips due a fall on antidepressants. A study published in 2017 also found a correlation between antidepressant use and the risk of hip fracture (Torvinen-Kiiskinen et al, International Journal of Geriatric Psychiatry, Dec. 2017).

Problems with Benzodiazepines:

Other medications can also make older people less steady on their feet. In 2009, researchers compared nine different classes of medications ( Archives of Internal Medicine, Nov. 23, 2009). They found that sleeping pills, anti-anxiety medicines and antidepressants increased the chance that an elderly patient would fall. Careful statistical analysis of 22 studies showed that sedatives and sleeping pills increased the risk of falls by more than 50 percent.

Benzodiazepines are prescribed to ease anxiety and help people sleep. They include medications such as lorazepam (Ativan), flurazepam (Dalmane), triazolam (Halcion), clonazepam (Klonopin), chlordiazepoxide (Librium), temazepam (Restoril), diazepam (Valium) and alprazolam (Xanax). This type of medicine was associated with a 57 percent increased risk of falls. Antidepressants and antipsychotic drugs were also linked to higher rates of falls. Even pain relievers such as ibuprofen, naproxen or diclofenac were associated with a 21 percent increase in the chance of falling.

One large community-based study found that use of inappropriate medications increased the risk for falls in elderly people (BMC Geriatrics, July 23, 2009). These scientists found, however, that the main culprit was long-acting benzodiazepines such as diazepam or flurazepam. These researchers also found that older people were more likely to fall on antidepressants. Antidepressants such as amitriptyline with strong anticholinergic activity were particularly hazardous.

What Other Medications Cause Fall Problems?

An article in JAMA Internal Medicine (Nov. 23, 2009) introduced the fall problem this way:

“Falling in elderly persons is a major, yet underrecognized public health concern. Falls and fall-related complications are the fifth leading cause of death in the developed world, and more than 30% percent of persons older than 65 years will fall at least once annually. Furthermore, falls are the primary reason for 85% of all injury-related admissions to hospital and for more than 40% of nursing home admissions. The annual costs associated with falls and fall-related complications have been estimated to be in the billions of dollars worldwide. As a result, research examining the contributions of different risk factors on falls and fall risks is urgently needed.”

Sixteen years later, falls on antidepressant drugs and other medications have still not been well studied. Blood pressure medications, beta blockers, sedatives, sleeping pills, antidepressants, benzodiazepines and narcotics have all been linked to falls. We wish healthcare professionals would perform very careful assessments when prescribing such drugs to older patients to make sure they are not at risk for falls.

Should the Doctor Deprescribe Your Medications?

If you worry that an older relative or you yourself may be at risk of a fall and fracture due to medicines you are taking, ask the prescribing physician to review the medication list and deprescribe any drugs that are not strictly necessary. The concept of deprescribing may not be familiar. However, this approach can dramatically reduce the number of potentially inappropriate medications an older adult is taking (Journal of the American Medical Directors Association, Dec. 20, 2018). That in turn decreases the likelihood of a fall.