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Case-control studies of cardiovascular medications as risk factors for clinically diagnosed depressive disorders in a
S B Patten1, J V Williams, E J Love
1Alberta Heritage Foundation for Medical Research, Calgary.
Insights
This study found a link between angiotensin converting enzyme (ACE) inhibitors and depressive disorders in hospitalized patients. The association was stronger in women and older adults, warranting further investigation.
Area of Science:
- Cardiovascular Therapeutics
- Psychiatric Epidemiology
- Pharmacovigilance
Background:
- Cardiovascular medications like digoxin, ACE inhibitors, beta-blockers, and calcium channel blockers may influence mood disorders.
- Understanding potential iatrogenic causes of depression is crucial for patient care.
Purpose of the Study:
- To investigate the association between common cardiovascular drugs and clinical diagnoses of depressive disorders.
- To evaluate if specific cardiovascular medications contribute to substance-induced mood disorders.
Main Methods:
- Two case-control studies were conducted using data from Calgary General Hospital.
- Subjects were selected based on discharge diagnoses of congestive heart failure or hypertension.
- Drug exposures were analyzed via chart review, comparing cases with psychiatric and nonpsychiatric controls.
Main Results:
- Digoxin, beta-blockers, and calcium channel blockers showed no association with depressive diagnoses.
- Angiotensin converting enzyme (ACE) inhibitors were associated with depressive disorders.
- The association with ACE inhibitors was more pronounced in female patients and those over 65.
Conclusions:
- This study provides the first epidemiological evidence linking ACE inhibitors to depressive disorders.
- The observed association requires further research to establish causality.
- Additional studies are necessary to confirm these findings and explore underlying mechanisms.
Objective:
Certain medications used in cardiovascular therapeutics may contribute to the etiology of substance-induced mood disorders. These medications include digoxin, angiotensin converting enzyme (ACE) inhibitors, beta-blockers, and calcium channel blockers. The objective of this study was to evaluate associations between these drugs and clinical diagnoses of depressive disorders in a population of hospitalized patients.
Method:
Two case-control studies were conducted. For each study, subjects were selected from a health records data base maintained at the Calgary General Hospital. Selection of subjects in the first study was restricted to those receiving a discharge diagnosis of congestive heart failure and in the second study to subjects receiving a discharge diagnosis of hypertension. In each of these 2 studies, a single case group was selected along with 2 control groups: a psychiatric control group consisting of subjects receiving a psychiatric diagnosis other than a depressive disorder and a nonpsychiatric control group receiving no psychiatric diagnoses. Drug exposures and other variables were recorded from a chart review.
Results:
Exposures to digoxin, beta-blockers, and calcium channel blockers were not associated with depressive diagnoses. An association was observed, however, for ACE inhibitors. An elevated odds ratio (OR) was observed in each case-control study and was stronger in female subjects and subjects over the age of 65.
Conclusions:
This is the first reported epidemiological evidence of an association between ACE inhibitors and depressive disorders. The design of this study does not permit a determination of whether the observed association was causal. Additional studies are needed.