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The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A
Marta M Maslej1, Benjamin M Bolker, Marley J Russell
1Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON, Canada.
Insights
Antidepressant (AD) use increases mortality and cardiovascular risks in the general population but not in patients with existing cardiovascular disease. This meta-analysis highlights differential health effects based on patient population and AD class.
Area of Science:
- Pharmacology and Toxicology
- Epidemiology
- Cardiovascular Medicine
Background:
- Antidepressants (ADs) are widely prescribed, yet their long-term health impacts remain controversial.
- ADs may disrupt physiological processes, potentially increasing mortality, but also possess anticlotting properties beneficial for cardiovascular health.
Purpose of the Study:
- To conduct a meta-analysis assessing the effects of ADs on all-cause mortality and cardiovascular events.
- To investigate the influence of patient population (general vs. cardiovascular) and AD class on these outcomes.
Main Methods:
- A systematic literature search of PubMed, EMBASE, and Google Scholar was performed.
- Two reviewers independently extracted data on mortality, cardiovascular events, and AD class, controlling for depression and comorbidities.
- Mixed-effect meta-analyses were used to test sample type and AD class as moderators.
Main Results:
- Seventeen studies were included in the meta-analysis.
- In general populations, AD use was associated with increased mortality (HR=1.33) and cardiovascular events (HR=1.14).
- In cardiovascular patients, AD use did not significantly alter mortality or cardiovascular event risks. 'Other ADs' showed increased mortality compared to TCAs.
Conclusions:
- The findings support the hypothesis that antidepressants pose risks in the general population.
- ADs appear less harmful in individuals with pre-existing cardiovascular conditions.
Background:
Antidepressants (ADs) are commonly prescribed medications, but their long-term health effects are debated. ADs disrupt multiple adaptive processes regulated by evolutionarily ancient biochemicals, potentially increasing mortality. However, many ADs also have anticlotting properties that can be efficacious in treating cardiovascular disease. We conducted a meta-analysis assessing the effects of ADs on all-cause mortality and cardiovascular events in general-population and cardiovascular-patient samples.
Methods:
Two reviewers independently assessed articles from PubMed, EMBASE, and Google Scholar for AD-related mortality controlling for depression and other comorbidities. From these articles, we extracted information about cardiovascular events, cardiovascular risk status, and AD class. We conducted mixed-effect meta-analyses testing sample type and AD class as moderators of all-cause mortality and new cardiovascular events.
Results:
Seventeen studies met our search criteria. Sample type consistently moderated health risks. In general-population samples, AD use increased the risks of mortality (HR = 1.33, 95% CI: 1.14-1.55) and new cardiovascular events (HR = 1.14, 95% CI: 1.08-1.21). In cardiovascular patients, AD use did not significantly affect risks. AD class also moderated mortality, but the serotonin reuptake inhibitors were not significantly different from tricyclic ADs (TCAs) (HR = 1.10, 95% CI: 0.93-1.31, p = 0.27). Only "other ADs" were differentiable from TCAs (HR = 1.35, 95% CI: 1.08-1.69). Mortality risk estimates increased when we analyzed the subset of studies controlling for premedication depression, suggesting the absence of confounding by indication.
Conclusions:
The results support the hypothesis that ADs are harmful in the general population but less harmful in cardiovascular patients.
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