Psy-World

Use of any antidepressants in postmenopausal women is associated with increased risks of all-cause mortality.

Depression is an independent risk factor for cardiovascular morbidity and mortality, but the effects of antidepressant use on these outcomes is less clear. Particularly among older women, who are at increased risk of both depression and cardiovascular disease, little is known about antidepressant safety. A large prospective cohort study examined whether an association existed between antidepressant use and cardiovascular morbidity and mortality in postmenopausal women. A total of 136,293 postmenopausal women were not taking any antidepressants at baseline and had at least 1 follow-up visit. Four percent (n=5496) were taking some antidepressant at the first follow-up visit following baseline, and the mean follow-up after the first follow-up visit was 5.86 years. New use of either selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) was not associated with the risk of coronary heart disease. However, antidepressant users had higher levels of several cardiovascular disease (CVD) risk factors than non-users. SSRI use was associated with increased stroke risk (hazard ratio (HR) = 1.45). SSRI and TCA use was associated with increased risk of all-cause mortality (HR = 1.32 and HR = 1.67, respectively). Annualized rates per 1000 person-years of stroke with no antidepressant use were 2.99 vs 4.16 for SSRI users. Death rates for non-antidepressant users were 7.79 per 1000 person-years and 12.77 for SSRI users. Annualized mortality rates for TCA users were 14.14 deaths per 1000 person-years. The excess risk for stroke seen in association with SSRIs was largely hemorrhagic (HR = 2.12), whereas the risk for ischemic stroke with SSRI use did not reach statistical significance (HR = 1.21). In contrast, both the SSRIs and the TCAs were associated with an increased risk for all fatal strokes (HR = 2.10 and HR = 2.56, respectively). These findings indicate that antidepressant use does have certain negative consequences in postmenopausal women and that its risks should be considered against the potential benefits of treating depression. Smoller JW, Allison M, Cochrane BB, Curb JD, Perlis RH, Robinson JG, Rosal MC, Wenger NK, Wassertheil-Smoller S (2009). Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the women's health initiative study. Arch Intern Med 169:2128-2139. Updated January 2010