Adverse health outcomes associated with long-term use of antidepressants

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Long-term use of antidepressants may double the risk of heart disease, according to the most comprehensive epidemiological study to date examining the health effects of antidepressant use over a decade, published in the British Journal of Psychiatry Open. University-led study analyzed data from more than 200,000 people.

Antidepressants are among the most widely prescribed medications in the U.K. In 2018, more than 70 million antidepressants were prescribed. The marked increase in prescriptions (nearly doubling in 10 years) is largely due to long-term treatment rather than an increase in diagnoses. However, little is known about the health effects of long-term use of these medications.

Researchers at the University of Bristol’s Academic Centre for Mental Health aimed to determine whether long-term use of antidepressants (5 and 10 years or longer) is associated with the development of six health problems (diabetes, hypertension, coronary heart disease, stroke and related syndromes, and two mortality outcomes (death from cardiovascular disease and death from any cause)) The goal of the study was to determine the following

Using data from U.K. Biobank, a large biomedical database and research resource containing anonymized genetic, lifestyle, and health information on 500,000 British participants, the researchers linked comprehensive health data on 222,121 adults aged 40 to 69 years with prescription and disease data (GP records) were linked.

The researchers compared the risk of developing adverse health outcomes between those who had never taken antidepressants and those who had taken the most commonly prescribed antidepressants in England for 10 years. These antidepressants were categorized as selective serotonin reuptake inhibitors, known as SSRIs, such as citalopram, sertraline, fluoxetine, and paroxetine, and non-SSRI antidepressants such as mirtazapine, venlafaxine, duloxetine, and trazodone.

The researchers found that after preexisting risk factors were taken into account, long-term use of antidepressants was associated with an increased risk of coronary heart disease, cardiovascular disease, and death from any cause. Risk was higher for non-SSRI antidepressants (mirtazapine, venlafaxine, duloxetine, and trazodone), and use of such drugs was associated with a twofold increased risk of coronary heart disease, cardiovascular death, and all cause mortality at 10 years.

There is also evidence that antidepressants, particularly SSRIs, are associated with a reduced risk of developing hypertension and diabetes (23-32% risk reduction). The reasons for these seemingly paradoxical findings are unclear, and further research is needed to understand to what extent differences are due to the severity of the underlying depression or to differences in drug action.

Dr. Narinder Bansal, lead author of the study and Honorary Research Fellow at the Academic Centre for Mental Health and Academic Primary Care in Bristol, said, “Although we considered a wide range of pre-existing risk factors for cardiovascular disease, including those associated with depression, such as overweight, smoking, and lack of exercise, It is difficult to fully control for the effects of depression in this type of study, as there can be considerable variability in the documentation of depression severity in primary care.

This is because “many individuals taking antidepressants such as mirtazapine, venlafaxine, duloxetine, and trazodone may have more severe depression. Thus, it is difficult to completely separate the effects of depression from the effects of medications. Further research is needed to assess whether the association seen here is truly drug-related and, if so, why.

The message for clinicians, however, is that long-term antidepressant prescribing is not always without harm. Hopefully, this study will help physicians and patients have a more informed conversation when weighing the potential risks and benefits of depression treatment. Regardless of whether antidepressants are the underlying cause of these problems, the findings underscore the importance of proactive cardiovascular monitoring and prevention in patients who develop depression and are taking antidepressants.

We recommend that anyone who has concerns about taking antidepressants for an extended period of time first consult with his or her physician before stopping taking them,” said Dr. Kurt Stein, a professor of medicine at the University of California, Berkeley. It is very important not to stop taking them abruptly.

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