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Antidepressant use may not increase risk for cardiovascular outcomes

Findings from a large observational study indicated no significant associations between selective serotonin reuptake inhibitors and increased risk for arrhythmia, myocardial infarction or stroke/transient ischemic attack in adults with depression.

“Depression increases the risk of cardiovascular outcomes, but controversy exists as to whether use of antidepressants, particularly selective serotonin reuptake inhibitors, increases or reduces the risk. This is important because antidepressants are one of the most commonly prescribed types of drug worldwide, and their use is increasing,” Carol Coupland, MSc, PhD, of the University of Nottingham, England, and colleagues wrote.

To evaluate associations between different antidepressant treatments and rates of cardiovascular outcomes, researchers assessed myocardial infarction, stroke/transient ischemic attack and arrhythmia in 238,963 individuals first diagnosed with depression between January 2000 and July 2011. Data was derived from United Kingdom general practices contributing to the QResearch primary care database. Study participants were aged 20 to 64 years.

During 5 years of follow-up, 772 participants had a myocardial infarction; 1,106 had a stroke or transient ischemic attack; and 1,452 were diagnosed with arrhythmia.

Researchers found no significant associations between antidepressant class and myocardial infarction over the study period.

In the first year of follow-up, participants treated with selective serotonin reuptake inhibitors had significantly reduced risk for myocardial infarction (adjusted HR = 0.58; 95% CI, 0.42-0.79), compared with no antidepressant use.

Individually, fluoxetine was associated with a significantly reduced risk for myocardial infarction (aHR = 0.44; 95% CI, 0.27-0.72), while lofepramine was associated with a significantly increased risk (aHR = 3.07; 95% CI, 1.5-6.26).

Antidepressant class was not significantly associated with arrhythmia during the 5-year follow-up; however, risk was significantly increased during the first 28 days of treatment with tricyclic and related antidepressants (aHR = 1.99; 95% CI, 1.27-3.13).

Fluoxetine was associated with a significantly reduced risk for arrhythmia (aHR = 0.74; 95% CI, 0.59-0.92), but citalopram was not, even at high doses.

Researchers did not find significant associations between antidepressant class and individual drugs and risk for stroke or transient ischemic attack.

“This large observational study has found no evidence that selective serotonin reuptake inhibitors are associated with an increased risk of arrhythmia, myocardial infarction or stroke/transient ischemic attack in people with depression aged 20 to 64, but some indication that they are associated with a reduced risk of myocardial infarction and arrhythmia, particularly for fluoxetine,” Coupland and colleagues wrote. “Citalopram was not significantly associated with an increased risk of arrhythmia, even at higher doses, although the confidence interval was wide. These findings are reassuring in light of recent safety concerns about selective serotonin reuptake inhibitors.” – by Amanda Oldt

Disclosure: Coupland reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.