The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis
| Autor: | Paul W. Andrews, Steven D. Hollon, Benjamin M. Bolker, Marley J. Russell, Keifer Eaton, Benoit H. Mulsant, Zachary Durisko, J. Anderson Thomson, G. Marie Swanson, Marta M. Maslej |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Comorbidity Disease Antidepressive Agents Tricyclic 03 medical and health sciences 0302 clinical medicine Risk Factors Econometrics medicine Humans 030212 general & internal medicine Mortality Prescribed medications Intensive care medicine Applied Psychology Depressive Disorder business.industry General Medicine Psychiatry and Mental health Clinical Psychology Cardiovascular Diseases Meta-analysis business Selective Serotonin Reuptake Inhibitors 030217 neurology & neurosurgery All cause mortality |
| Zdroj: | Psychotherapy and Psychosomatics. 86:268-282 |
| ISSN: | 1423-0348 0033-3190 |
| DOI: | 10.1159/000477940 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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