Antidepressant use and risk of adverse outcomes: population-based cohort study

Narinder Bansal; Mohammed Hudda; Rupert A Payne; Daniel J. Smith; David S Kessler; Nicola J Wiles

doi:10.1192/bjo.2022.563

Antidepressant use and risk of adverse outcomes: population-based cohort study

Narinder Bansal^*
, Mohammed Hudda
, Rupert A Payne
, Daniel J. Smith
, David S Kessler
, Nicola J Wiles

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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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 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.

Results
SSRI treatment was associated with decreased 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.

Original language	English
Article number	e164
Pages (from-to)	1-9
Number of pages	9
Journal	BJPsych Open
Volume	8
Issue number	5
DOIs	https://doi.org/10.1192/bjo.2022.563
Publication status	Published - 13 Sept 2022

Bibliographical note

Funding Information:
This research is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (grant number 422 awarded to Bansal (Principal Investigator), Payne, Kessler and Wiles). The views expressed are those of the author(s) and not necessarily those of the NIHR, NHS or Department of Health. This study was also supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (Kessler and Wiles). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Publisher Copyright:
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

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@article{9c556c3b5ad34933bf3521174cdcc185,

title = "Antidepressant use and risk of adverse outcomes: population-based cohort study",

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 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 {\textquoteleft}other{\textquoteright}) 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. Results SSRI treatment was associated with decreased 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 {\textquoteleft}other{\textquoteright} 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.",

author = "Narinder Bansal and Mohammed Hudda and Payne, \{Rupert A\} and Smith, \{Daniel J.\} and Kessler, \{David S\} and Wiles, \{Nicola J\}",

note = "Funding Information: This research is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (grant number 422 awarded to Bansal (Principal Investigator), Payne, Kessler and Wiles). The views expressed are those of the author(s) and not necessarily those of the NIHR, NHS or Department of Health. This study was also supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (Kessler and Wiles). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: Copyright {\textcopyright} The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.",

year = "2022",

month = sep,

day = "13",

doi = "10.1192/bjo.2022.563",

language = "English",

volume = "8",

pages = "1--9",

journal = "BJPsych Open",

issn = "2056-4724",

publisher = "Cambridge University Press",

number = "5",

}

TY - JOUR

T1 - Antidepressant use and risk of adverse outcomes

T2 - population-based cohort study

AU - Bansal, Narinder

AU - Hudda, Mohammed

AU - Payne, Rupert A

AU - Smith, Daniel J.

AU - Kessler, David S

AU - Wiles, Nicola J

N1 - Funding Information: This research is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (grant number 422 awarded to Bansal (Principal Investigator), Payne, Kessler and Wiles). The views expressed are those of the author(s) and not necessarily those of the NIHR, NHS or Department of Health. This study was also supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (Kessler and Wiles). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

PY - 2022/9/13

Y1 - 2022/9/13

N2 - 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 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. Results SSRI treatment was associated with decreased 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.

AB - 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 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. Results SSRI treatment was associated with decreased 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.

U2 - 10.1192/bjo.2022.563

DO - 10.1192/bjo.2022.563

M3 - Article (Academic Journal)

C2 - 36097725

SN - 2056-4724

VL - 8

SP - 1

EP - 9

JO - BJPsych Open

JF - BJPsych Open

IS - 5

M1 - e164

ER -

Antidepressant use and risk of adverse outcomes: population-based cohort study

Abstract

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