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Older generation antidepressants linked to heart disease

Doctors should be cautious about prescribing tricyclic antidepressants

Caroline White

Wednesday, 01 December 2010

The tricyclic class of older generation antidepressants is associated with an increased risk of heart attack and stroke, suggests research published online in the European Heart Journal today.

The researchers tracked the health of almost 15,000 men and women without a known history of cardiovascular disease, using data from the Scottish Health Survey, which collects information from the general population every three to five years.

They combined data from three separate surveys in 1995, 1998, and 2003 in adults aged over 35 and linked them with records on hospital admissions and deaths until 2007.

The surveys quizzed participants about their lifestyle, and measured height and weight and levels of psychological distress. Information on medical history, including psychiatric hospital admissions and medication, was also collected.

Some 2.2% of participants said they took tricyclic antidepressants; a further 2% said they took newer generation selective serotonin reuptake inhibitors (SSRIs); and 0.7% said they took other antidepressants.
During an average of eight years, 1434 events associated with cardiovascular disease occurred, of which around one in four (26.2%) were fatal.

After adjusting for various influential factors, including indicators of mental illness, the researchers found that taking tricyclic antidepressants was associated with a 35% increased risk of cardiovascular disease. No excess risk was found for SSRIs.

Lead author Dr Mark Hamer of the Department of Epidemiology and Public Health at UCL London said that his study contained a truly representative population sample, making the results applicable to the wider community.

“[Most] previous work in this area has focused on clinical cardiac patients, so studies in healthy participants are very important. Given that antidepressants, such as SSRIs, are now prescribed not only for depression, but for a wide range of conditions such as back pain, headache, anxiety and sleeping problems, the risks associated with antidepressants have increasing relevance to the general population,” he said.
He added: “Our findings suggest that there is an association between the use of tricyclics and an increased risk of cardiovascular disease that is not explained by existing mental illness. Tricyclics are known to have a number of side effects: they are linked to increased blood pressure, weight gain and diabetes and these are all risk factors for CVD.”
And he concluded: “Our findings suggest that clinicians should be cautious about prescribing antidepressants and should also consider lifestyle advice, such as smoking cessation, exercise, and sensible alcohol intake.”

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