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Cardiovascular death and manic-depressive psychosis
1Institute of Psychiatric Demography, Aarhus Psychiatric Hospital, Risskov, Denmark.
Insights
Tricyclic antidepressant drugs (TCA) do not increase cardiovascular death risk in manic-depressive patients. Findings suggest TCAs may even reduce risks of cardiovascular disease, suicide, and other non-cancer deaths.
Area of Science:
- Psychiatry
- Cardiology
- Pharmacology
Background:
- Manic-depressive illness (bipolar disorder) is associated with increased mortality.
- Tricyclic antidepressants (TCAs) are commonly prescribed for mood disorders.
- Concerns exist regarding the cardiovascular safety of TCAs.
Purpose of the Study:
- To investigate whether therapeutic doses of TCAs increase cardiovascular mortality risk in manic-depressive patients.
- To compare cardiovascular mortality rates before and during the widespread use of TCAs.
Main Methods:
- Retrospective cohort study using the Danish Psychiatric Central Register.
- Inclusion of two groups of first-hospitalized manic-depressive men: pre-TCA era (1950-1956) and TCA era (1969-1976).
- Follow-up period of approximately 4.5 years for both groups.
Main Results:
- Relative cardiovascular mortality was 1.87 in the pre-TCA group (n=1133) and 1.53 in the TCA era group (n=2662) compared to the general population.
- The observed rates do not support the hypothesis that TCAs increase cardiovascular mortality.
- A potential reduction in cardiovascular disease, suicide, and other non-cancer deaths was suggested with TCA treatment.
Conclusions:
- Tricyclic antidepressants (TCAs) do not appear to elevate cardiovascular mortality risk in individuals with manic-depressive illness.
- TCA treatment may be associated with a reduced risk of death from cardiovascular causes, suicide, and other non-cancerous conditions.
- Further research is warranted to confirm the potential protective effects of TCAs.
Abstract:
In order to study if tricyclic antidepressant drugs (TCA) in therapeutic doses increase the risk of death due to cardiovascular causes, the relative mortality from cardiovascular diseases was studied in two large groups of first hospitalized manic-depressive patients, one from the TCA era, the other from the period just before the introduction of TCA. Both groups were selected from the Danish Psychiatric Central Register and followed for an average of 4.5 years. Among 2662 manic-depressive men hospitalized between 1969 and 1976, the relative cardiovascular mortality was 1.53 compared to the general population. Among 1133 such cases admitted between 1950 and 1956, the rate was 1.87. Our findings do not support the hypothesis that TCA contribute to the cardiovascular mortality in manic-depressives and even support suggestions that TCA treatment may lower the risk of death by cardiovascular disease, suicide, and other non-cancer causes.