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Study finds no link between SSRI drugs and heart risk

Large study provides reassurance after safety concerns over SSRIs

Adrian O'Dowd

Wednesday, 23 March 2016

People who take the commonly used selective serotonin reuptake inhibitors (SSRI) antidepressants are not raising their risk of heart attacks or strokes, suggests a study*published in The BMJ today.

Depression is known to increase the risk of cardiovascular outcomes, but it is not clear whether antidepressants, particularly SSRIs, increase or reduce the risk.

In the new study, a team of UK-based researchers led by Carol Coupland, professor of medical statistics in primary care at University of Nottingham, examined associations between different antidepressant treatments, and rates of three cardiovascular outcomes in people with depression.

The study included 238,963 patients aged 20-64 with a diagnosis of depression made between 2000 and 2011, identified using the UK QResearch database.

The researchers looked at antidepressant class, including tricyclic and related antidepressants, SSRIs, and other types, as well as dosage and duration of use.

The participating patients were monitored for heart attacks, strokes or transient ischaemic attacks, and arrhythmia, and followed up until 2012.

Various factors such as age, sex, smoking status, alcohol consumption, co-morbidities and use of other drugs were taken into account.

Results showed that during five years of follow-up, 772 patients had a myocardial infarction, 1,106 had a stroke or transient ischaemic attack, and 1,452 were diagnosed as having arrhythmia.

Overall, the study found no evidence that SSRIs were associated with an increased risk of arrhythmia, heart attacks, or stroke/transient ischaemic attacks in people with depression over the five-year period.

However, there was a significant doubling of risk for arrhythmia during the first four weeks of taking tricyclic and related antidepressants.

In addition, there was some indication that SSRIs were associated with a reduced risk of heart attacks, particularly with the use of fluoxetine.

Absolute risks of heart attacks were 6 per 10,000 for SSRIs over one year, and 4 per 10,000 for fluoxetine compared with 10 per 10,000 for non-use. 

Citalopram, the most commonly prescribed drug among patients in the study, was not associated with an increased risk of arrhythmia, even at higher doses.

In 2011, the FDA (Food and Drug Administration) in the US and EMA (European Medicines Agency) both issued warnings about taking high doses of the drug following safety concerns.

However, the authors said they could not rule out the possibility of an increased risk of arrhythmia in patients taking citalopram at high doses because only a relatively small proportion of citalopram prescriptions (18%) were at high doses in the study.

This was an observational study so no firm conclusions can be made between cause and effect, but the authors concluded: “These findings are reassuring in light of recent safety concerns about selective serotonin reuptake inhibitors.”

* Coupland C, et al. Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database. BMJ 2016;352:i1350 doi: 10.1136/bmj.i1350

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