Kouta Ito, MD, MS
What is the relation between antidepressant treatment and adverse outcomes in elderly patients with depression?
Cohort study using data from a primary care research database, linked with death certificates. Mean follow-up was 5.0 years.
570 general practices in the UK.
60 746 patients 65 to 99 years of age (mean age 75 y, 67% women) with depression diagnosed at ≥ 65 years of age (index diagnosis). Exclusion criteria were diagnosis of depression ≤ 12 months after registration with a study practice or after electronic health record installation; temporary residency; diagnosis of depression ≤ 12 months before index diagnosis; antidepressant prescription ≤ 12 months before index diagnosis; or schizophrenia, bipolar disorder, or other types of psychoses.
Antidepressant prescription, by drug class (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors, selective serotonin reuptake inhibitors [SSRIs], and other antidepressants [e.g., venlafaxine and mirtazapine]).
Outcomes included all-cause mortality, attempted suicide or self-harm, myocardial infarction (MI), stroke or transient ischemic attack (TIA), falls, fractures, upper gastrointestinal (GI) bleeding, epilepsy or seizures, and hyponatremia.
54 038 (89%) patients received ≥ 1 prescription for an antidepressant. Compared with periods of no antidepressant treatment, all classes of antidepressants were associated with increased risk for all-cause mortality (Table); attempted suicide or self-harm (Table); and falls, fractures, and upper GI bleeding. SSRIs were associated with increased risk for stroke or TIA, epilepsy or seizures, MI, and hyponatremia. Compared with TCAs, SSRIs were associated with higher risk for all-cause mortality (adjusted hazard ratio 1.32, 95% CI 1.26 to 1.39), stroke or TIA, falls, fractures, epilepsy or seizures, and hyponatremia.
In elderly patients with depression, antidepressants were associated with increased risk for mortality, attempted suicide or self-harm, and other serious adverse outcomes. Selective serotonin reuptake inhibitors were associated with a higher risk for several adverse outcomes than tricyclic antidepressants.
*SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; other abbreviations defined in Glossary.
†Number of events in unadjusted analysis.
‡Adjusted for sex, age, year, depression severity, depression before age 65, smoking status, Townsend deprivation score, comorbidities, use of other drugs, and stroke or transient ischemic attack at baseline.
Kouta Ito. Antidepressants were associated with increased risk for adverse outcomes in depressed elders. Ann Intern Med. 2012;156:JC2–13. doi: 10.7326/0003-4819-156-4-201202210-02013
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Published: Ann Intern Med. 2012;156(4):JC2-13.
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