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Antidepressant use increased risk for death, stroke in postmenopausal women

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Postmenopausal women who reported using tricyclic antidepressants and selective serotonin reuptake inhibitors had a slightly increased risk for mortality and hemorrhagic and fatal stroke, according to new findings from the Women’s Health Initiative study.

Despite the common use of antidepressants, their effect on cardiovascular morbidity and mortality remains unclear. Researchers compared the association in 136,293 postmenopausal women included in the WHI who were and were not (n=5,496) using antidepressants. About 55% were using only selective serotonin reuptake inhibitors; 27.1% tricyclic antidepressants only; and 17.6% another antidepressant or multiple antidepressants.

After a mean 5.9 years of follow-up, researchers reported an increased risk for stroke (HR=1.45; 95% CI, 1.08-1.97) and all-cause mortality (HR=1.32; 95% CI, 1.10-1.59) with use of a selective serotonin reuptake inhibitor. Use was also associated with hemorrhagic stroke (HR=2.12; 95% CI, 1.10-4.07) and fatal stroke (HR=1.20; 95% CI, 1.15-3.81).

Postmenopausal women who used tricyclic antidepressants had an increased risk for all-cause mortality (HR=1.67; 95% CI, 1.33-2.09).

The overall risks were small —less than 2% per year for all groups — but the increase was statistically significant, according to the researchers.

The researchers observed no risk for coronary heart disease with overall antidepressant use.

No significant differences were reported in outcomes between selective serotonin reuptake inhibitors and tricyclic antidepressants.

“These findings must be weighed against quality of life and established risks of CV disease and mortality associated with untreated depression,” the researchers concluded.

“No one should stop taking their prescribed medication based on this one study, but women who have concerns should discuss them with their physicians,” Jordan W. Smoller, MD, ScD, of the department of psychiatry at the Massachusetts General Hospital, said in a press release.

Smoller J. Arch Intern Med. 2009;169:2128-2139.