Abstract
Background
Antidepressants are one of the most widely prescribed drugs in the global north. However, little is known about the health consequences of long-term treatment.
Aims
This study aimed to investigate the association between antidepressant use and adverse events.
Method
The study cohort consisted of UK Biobank participants aged 40–69 years between 2006 and 2010. whose data was linked to primary care records (N = 222 121). We assessed the association between antidepressant use by drug class (selective serotonin reuptake inhibitors (SSRIs) and ‘other’) and four morbidity (diabetes, hypertension, coronary heart disease (CHD), cerebrovascular disease (CV)) and two mortality (cardiovascular disease (CVD) and all-cause) outcomes, using Cox’s proportional hazards model at 5- and 10-year follow-up.
On average (median) participants were aged 56–57 years, around half of the participants or just over were female, and 96% were of White ethnicity.
Results
SSRI treatment was associated with increased risk of diabetes at 5 years (hazard ratio 0.64, 95% CI 0.49–0.83) and 10 years (hazard ratio 0.68, 95% CI 0.53–0.87), and hypertension at 10 years (hazard ratio 0.77, 95% CI 0.66–0.89). At 10-year follow-up, SSRI treatment was associated with increased risks of CV (hazard ratio 1.34, 95% CI 1.02–1.77), CVD mortality (hazard ratio 1.87, 95% CI 1.38–2.53) and all-cause mortality (hazard ratio 1.73, 95% CI 1.48–2.03), and ‘other’ class treatment was associated with increased risk of CHD (hazard ratio 1.99, 95% CI 1.31–3.01), CVD (hazard ratio 1.86, 95% CI 1.10–3.15) and all-cause mortality (hazard ratio 2.20, 95% CI 1.71–2.84).
Conclusions
Our findings indicate an association between long-term antidepressant usage and elevated risks of CHD, CVD mortality and all-cause mortality. Further research is needed to assess whether the observed associations are causal, and elucidate the underlying mechanisms.
Einige interessante Fakten (bezogen auf UK) aus dem Fulltext:
- Seventy million prescriptions were dispensed in 2018
- One Scottish study found that over half of patients on antidepressants had been taking them for more than 2 years, with a mean treatment duration of 5.5 years.
- Depression is strongly associated with adverse risk profiles such as excess adiposity, smoking, poor diet and physical inactivity.
- Therefore, careful assessment of the long-term cardiometabolic effects of antidepressant treatment is critical.
- The main challenge for observational studies examining potential adverse outcomes of long-term antidepressant use is accounting for the excess cardiovascular risk associated with depression (confounding by indication).
- Given the multifactorial nature of depression and cardiometabolic disease, information on a wide range of prospectively measured confounders, including lifestyle, sociodemographic factors and baseline biomarkers for cardiometabolic disease, are needed to provide robust estimates of the risks associated with long-term antidepressant use. This requires richly phenotyped cohorts. One such cohort is UK Biobank, which is a large population-based cohort study (approximately 500 000 participants
- This open-access resource has detailed information on socioeconomic status; demographics; anthropometric, behavioural and biochemical risk factors; disability and health status with linkages to routinely available national data-sets including primary care records and deaths. We used the UK Biobank data-set to examine the association between antidepressant use and four cardiometabolic morbidity outcomes (diabetes, hypertension, cerebrovascular disease (CV), coronary heart disease (CHD)) and two mortality outcomes (cardiovascular disease (CVD) mortality and all-cause mortality).
Christine: Eine sehr wichtige Studie bzw. „Hinschauen“, was wir da so machen und wahrscheinlich sind die post-Covid-Verschreibungen noch höher. Erst am Wochenende hatten wir bei der Erstkommunion wieder ein größeres Fest daheim und ich war erstaunt, dass auch innerfamiliär und im Bekanntenkreis durchaus Antidepressiva in der Pandemie begonnen wurden. Das aus dem Nähkästchen
Verwundert hat mich, dass UK wohl eine wirklich gute Datenbank hat, da scheinen sie ähnlich zu den Skandinaviern aufgestellt zu sein.
Nun stand im Abstract, dass man ja immer fix rüber kopiert, dass es eine SENKUNG des Diabetes Risiko nach 5 Jahren gibt. Ich habe mir nun den Fulltext angeschaut und da steht definitiv ERHÖHUNG. Ich habe es korrigiert.
Für uns als Hausärzte denke ich, dass wir wirklich daran arbeiten müssen von diesen Langzeitverschreibungen wegzukommen. Was natürlich intensive Arbeit bedeutet und die Fachärzte oft nicht mitziehen. Aber bei Therapeutenmangel überall fällt mir nichts ein.
Fazit:
Wir sollten versuchen, Antidepressiva möglichst spät einzusetzen und rasch strukturiert wieder auszuschleichen (6-24 Monate).