September: antidepressant study | News and Features
Long-term use of antidepressants can double the risk of heart disease, according to the most comprehensive epidemiological study to date to investigate the health consequences of using the drug over ten years. The University of Bristol-led study, published in the British Journal of Psychiatry Open, analyzed data on more than 200,000 people.
Antidepressants are one of the most prescribed drugs in England. In 2018, over 70 million prescriptions for antidepressants were dispensed. The striking increase in prescriptions (which has almost doubled in a decade) is mainly due to long-term treatment rather than an increase in the number of diagnoses. However, little is known about the health consequences of long-term use of these drugs.
Researchers from the Center for Academic Mental Health in Bristol investigated whether long-term use of antidepressants (over five and ten years) was associated with the onset of six health conditions: diabetes, high blood pressure, coronary heart disease , stroke and related syndromes, and two mortality outcomes (death from cardiovascular disease and from any cause).
Use of data from UK Biobanka large-scale biomedical database and research resource containing anonymised information on the genetics, lifestyle and health of half a million UK participants, the team linked comprehensive health data with prescription and disease data (using GP records) on 222,121 adults aged 40-69. year.
They compared the risk of developing adverse health effects between those who had not taken antidepressants and those who had been treated with the most commonly prescribed antidepressants in England for ten years. These have been categorized by drug class as selective serotonin reuptake inhibitors often known as SSRIs called citalopram, sertraline, fluoxetine and paroxetine and “other” non-SSRI antidepressants called mirtazapine, venlafaxine , duloxetine and trazodone.
The researchers found that once pre-existing risk factors were taken into account, long-term use of antidepressants was associated with an increased risk of coronary heart disease and an increased risk of death from cardiovascular disease and regardless of be the cause. Risks were greatest for non-SSRI antidepressants (mirtazapine, venlafaxine, duloxetine, trazodone), with use of these drugs associated with a two-fold increased risk of coronary heart disease, cardiovascular mortality, and all-cause mortality at ten years. .
There was also evidence that antidepressants, and in particular SSRIs, were associated with a reduced risk (23-32% lower risk) of developing high blood pressure and diabetes. The reasons for these seemingly paradoxical results are unclear and further work is needed to understand to what extent the differences are due to the severity of the underlying depression or the mode of action of the different medications.
Dr Narinder Bansal, lead author of the study and honorary research fellow at the Center for Academic Mental Health and Center for Academic Primary Care in Bristol, said: “While we considered a wide range of pre-existing risk factors for cardiovascular diseases, including those linked to depression such as excess weight, smoking, and low physical activity, it is difficult to fully control for the effects of depression in this type of study, in part because there are considerable variability in recording depression severity in primary care.
“This is important because many people taking antidepressants such as mirtazapine, venlafaxine, duloxetine and trazodone may have more severe depression. It is therefore difficult to completely separate the effects of depression from the effects of the medications. Research More is needed to assess whether the associations we observed are truly due to the drugs, and if so, why this might be the case.
“In the meantime, our message to clinicians is that prescribing antidepressants long-term may not be safe. We hope this study will help physicians and patients have more informed conversations when weighing the potential risks and benefits of treatments for depression. Whether or not medications are the underlying cause of these problems, our findings underscore the importance of proactive cardiovascular monitoring and prevention in patients with depression and on antidepressants, given that the two have been associated at higher risks.
“For anyone with concerns about their long-term use of antidepressants, we would urge them to speak to their GP first before stopping the medication. It is very important that they do not stop not to take them suddenly.
The study was funded by the National Institute for Health and Care (NIHR) Research School for Primary Care Research (NIHR SPCR) and was also supported by the National Institute of Health and Care (NIHR) Bristol Biomedical Research Center (NIHR Bristol BRC) a partnership between University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol.
‘Use of antidepressants and risk of adverse effects: a population-based cohort study’ by Narinder Bansalet al. in the British Journal of Psychiatry [open access]
1.’Community prescriptions: England 2005-2015‘ Health and Social Information Center Prescription and Medicines Team [05 July 2016].
2.’The NHS prescribed a record number of antidepressants last year‘ by Iacobucci G. et al. in BMJ [2019; 364: l1508]
3.’UK Biobank: an open-access resource for identifying the causes of a wide range of complex diseases of middle age and old age‘ by Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, et al. om PLOS Medicine [2015; 12(3): e1001779]
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UK Biobank is a large-scale biomedical database and research resource containing anonymised information on the genetics, lifestyle and health of half a million UK participants. The UK Biobank database, which includes blood samples, heart and brain scans and genetic data from volunteer participants, is accessible worldwide to registered researchers undertaking health-related research in the public interest. .
UK Biobank recruited 500,000 people aged 40-69 between 2006 and 2010 across the UK. With their consent, they provided detailed information about their lifestyle, physical measurements, and had blood, urine, and saliva samples collected and stored for future analysis.
UK Biobank’s research resource is a major contributor to the advancement of modern medicine and treatment, enabling better understanding of the prevention, diagnosis and treatment of a wide range of serious and life-threatening diseases, including cancer, heart disease and stroke. Since
The UK Biobank resource was opened for research in April 2012 and since then 30,000 researchers from 100 countries have been granted permission to use it and over 5,000 peer-reviewed articles that have used the resource have now been published.
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About the National Institute for Health and Care Research Bristol Biomedical Research Center (NIHR Bristol BRC)
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