Key result
In fully adjusted models, antidepressant use was associated with a small increase in all-cause mortality (HR 1.12; 95% CI 1.01-1.24).
Why the study?
Does second-generation antidepressant use increase the risk of acute CHD, stroke, CVD death, and all-cause mortality in a longitudinal cohort?
Cohort (n=29,616)
Does second-generation antidepressant use increase the risk of acute CHD, stroke, CVD death, and all-cause mortality in a longitudinal cohort?
Hazard Ratio: 1.12 (95% CI 1.01–1.24)
Second-generation antidepressant use is associated with a small increase in all-cause mortality, though initial associations with cardiovascular events were attenuated after full adjustment for physical and mental health covariates.
Antidepressant use was associated with modestly higher all-cause mortality; leaves open confounding versus causal risk and does not support practice change.
BACKGROUND: Mixed evidence suggests that second-generation antidepressants may increase the risk of cardiovascular and cerebrovascular events. OBJECTIVE: To assess whether antidepressant use is associated with acute coronary heart disease (CHD), stroke, cardiovascular disease (CVD) death, and all-cause mortality. METHODS: Secondary analyses of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study were conducted. Use of selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, bupropion, nefazodone, and trazodone was measured during the baseline (2003-2007) in-home visit. Outcomes of CHD, stroke, CVD death, and all-cause mortality were assessed every 6 months and adjudicated by medical record review. Cox proportional hazards time-to-event analysis followed patients until their first event on or before December 31, 2011, iteratively adjusting for covariates. RESULTS: Among 29 616 participants, 3458 (11.7%) used an antidepressant of interest. Intermediate models adjusting for everything but physical and mental health found an increased risk of acute CHD (hazard ratio [HR] = 1.21; 95% CI = 1.04-1.41), stroke (HR = 1.28; 95% CI = 1.02-1.60), CVD death (HR = 1.29; 95% CI = 1.09-1.53), and all-cause mortality (HR = 1.27; 95% CI = 1.15-1.41) for antidepressant users. Risk estimates trended in this direction for all outcomes in the fully adjusted model but only remained statistically associated with increased risk of all-cause mortality (HR = 1.12; 95% CI = 1.01-1.24). This risk was attenuated in sensitivity analyses censoring follow-up time at 2 years (HR = 1.37; 95% CI = 1.11-1.68). CONCLUSIONS: In fully adjusted models, antidepressant use was associated with a small increase in all-cause mortality.
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Hansen et al. (2016) reported a cohort. Antidepressant medication vs. No antidepressant use was evaluated on All-cause mortality (HR 1.12, 95% CI 1.01-1.24). In fully adjusted models, antidepressant use was associated with a small increase in all-cause mortality (HR 1.12; 95% CI 1.01-1.24).
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