Antidepressants raise risk for pneumonia, exacerbation in COPD

Key takeaways:

• After using an antidepressant, the risk for pneumonia and COPD exacerbations went up.
• Discontinuing antidepressants got rid of these heightened risks.

Patients with COPD on antidepressants faced a heightened risk for pneumonia and exacerbations, according to results published in Thorax.

“Antidepressants are associated with an increased risk of both pneumonia and COPD exacerbation in the 90 days following a prescription of antidepressant,” Rayan A. Siraj, PhD, of the department of respiratory care at King Faisal University in Saudi Arabia and the division of respiratory medicine at University of Nottingham, U.K., and colleagues wrote.

In a self-controlled case series, Siraj and colleagues assessed 31,253 individuals (mean age, 65 years; 56% women) from The Health Improvement Network in the U.K. who had COPD and an antidepressant prescription to determine if this prescription puts patients at a higher risk for pneumonia and COPD exacerbations.

This study included four antidepressant prescription classes, which were evaluated individually and all together: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors.

More than half of the total cohort experienced a COPD exacerbation (n = 18,483), whereas fewer patients suffered with pneumonia (n = 1,969). A small number of patients had both outcomes (n = 613).

Following adjustment for age, researchers found that patients faced an elevated risk for pneumonia (adjusted incidence rate ratio [aIRR] = 1.79; 95% CI, 1.54-2.07) and a COPD exacerbation (aIRR = 1.16; 95% CI, 1.13-1.2) in the 90-day period after receiving any of the included antidepressant prescriptions vs. a period without antidepressant exposure.

The heightened risks for both these outcomes during this time period were also seen with SSRI/SNRI and TCA prescriptions.

When patients stopped using antidepressants, the increased risk found for each outcome went away, according to researchers.

Notably, during the remainder period (after day 91), the risks for pneumonia and a COPD exacerbation went up compared with what was observed in the 90-day period (pneumonia, aIRR = 1.88; 95% CI, 1.68-2.11; exacerbation, aIRR = 1.38; 95% CI, 1.34-1.41).

Additionally, researchers factored in the season to see if this variable changed the main result, and they observed findings comparable with those outlined above.

“Although causal relationships cannot be established from this observational study, the findings should raise awareness of if any side effects that may be particularly problematic for the individual,” Siraj and colleagues wrote. “It is also important to consider nonpharmacological therapies that have been shown to improve mental health disorders, such as psychological support.”