Commonly used antidepressants, known as ‘selective serotonin reuptake inhibitors’ (SSRIs), are not associated with an increased risk of cardiovascular conditions, such as heart attacks and strokes in people aged below 65, according to new research at The University of Nottingham.
Depression is known to increase the risk of cardiovascular problems, but whether antidepressants, particularly selective serotonin reuptake inhibitors, increase or reduce this risk remains controversial. The results are significant because antidepressants are one of the most commonly prescribed drugs worldwide and cardiovascular diseases are a leading cause of death and disability.
The study which was funded by the NIHR School for Primary Care Research was led by the University’s Division of Primary Care and is published in The BMJ. The researchers examined associations between different antidepressant drugs and rates of three cardiovascular outcomes in people with depression.
Medical records of 238,963 patients aged 20-64 with a diagnosis of depression from the UK QResearch database were used for the study. Patients’ records were then reviewed for use of antidepressants and occurrence of heart attacks, strokes or transient ischaemic attacks, and arrhythmia (an irregular heartbeat).
The researchers looked at antidepressant class, including tricyclic and related antidepressants, selective serotonin reuptake inhibitors, and other types, as well as dosage and duration of use over a five year period. Factors such as age, sex, smoking status, alcohol consumption, co-morbidities and use of other drugs were accounted for.
Professor of Medical Statistics in Primary Care, Carol Coupland, said: “We found no evidence that SSRIs were associated with an increased risk of arrhythmia, heart attacks, or stroke in people with depression over the five-year period. But there was a significant doubling of risk for arrhythmia during the first four weeks of taking tricyclic and related antidepressants.
“We found some indication that SSRIs particularly fluoxetine were associated with a reduced risk of heart attacks. Absolute risks of heart attacks were 6 per 10,000 for selective serotonin reuptake inhibitors over 1 year, and 4 per 10,000 for fluoxetine compared with 10 per 10,000 for non-use.”
Citalopram, the most commonly prescribed antidepressant drug among patients in the study, was not associated with an increased risk of arrhythmia, even at higher doses. In 2011, the United States Food and Drug Administration and the European Medicines Agency both issued warnings about taking high doses of this drug following safety concerns. Nevertheless the researchers say they can't rule out the possibility of an increased risk of arrhythmia in patients taking citalopram at high doses because only a relatively small number of people in the study were treated with high doses. Therefore they recommend that high doses should not be prescribed without a strong indication, particularly for patients with any risk factors for arrhythmia.
This is an observational study so no firm conclusions can be made between cause and effect. Nevertheless, the authors say: "These findings are reassuring in the light of recent cardiac safety concerns about selective serotonin reuptake inhibitors."
Research: Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database
Journal: The BMJ
Link to full research paper: http://www.bmj.com/cgi/doi/10.1136/bmj.i1350
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