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Regular Article

The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis

Maslej M.M.a · Bolker B.M.b · Russell M.J.a · Eaton K.c · Durisko Z.a, d · Hollon S.D.e · Swanson G.M.f · Thomson Jr. J.A.g, h · Mulsant B.H.i · Andrews P.W.a

Author affiliations

Departments of aPsychology, Neuroscience, and Behaviour, bBiology and Mathematics & Statistics, and cBiochemistry, McMaster University, Hamilton, ON, and dSocial Aetiology of Mental Illness (SAMI) CIHR Training Program, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; eDepartment of Psychology, Vanderbilt University, Nashville, TN, USA; fCollege of Public Health, Hamad bin Khalifa University, Doha, Qatar; gCounseling and Psychological Services, University of Virginia Student Health, and hInstitute of Law, Psychiatry, and Public Policy, University of Virginia, Charlottesville, VA, USA; iCentre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Related Articles for ""

Psychother Psychosom 2017;86:268-282

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Article / Publication Details

First-Page Preview
Abstract of Regular Article

Received: November 09, 2016
Accepted: May 30, 2017
Published online: September 14, 2017
Issue release date: October 2017

Number of Print Pages: 15
Number of Figures: 3
Number of Tables: 0

ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)

For additional information: http://www.karger.com/PPS

Abstract

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.

© 2017 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Regular Article

Received: November 09, 2016
Accepted: May 30, 2017
Published online: September 14, 2017
Issue release date: October 2017

Number of Print Pages: 15
Number of Figures: 3
Number of Tables: 0

ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)

For additional information: http://www.karger.com/PPS


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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