Dr. Adams
12-27-2009, 10:32 AM
"Postmenopausal women taking either a tricyclic antidepressant (TCA) or a selective serotonin-reuptake inhibitor (SSRI) appear to be at increased risk for all-cause mortality, and SSRIs users seem to be at increased risk for hemorrhagic and fatal stroke.
In contrast, compared with women who did not use antidepressants, those using SSRIs had a 45% increased relative risk of incidence stroke and a 32% increased risk of death in models stratified on propensity. TCA use in turn was associated with a 67% higher relative risk for all-cause death. The TCAs also increase stroke risk, but not significantly so.
Depression is still a much more established risk factor for cardiovascular disease (CVD) than antidepressants, so it's not as though not taking an antidepressant removes the risk because then you have untreated depression, which itself is risky. But if a woman is concerned about taking medication, there are alternative treatments for depression, such as cognitive behavioral therapy, which can be effective.
A key question is whether the association between antidepressant use and CV morbidity and mortality is truly related to drug exposure or to underlying differences in other CV risk factors, including depression....the propensity score used in this study did help control for risk factors that could have explained differences in CV outcomes between antidepressant users and nonusers,"but you can't fully tease out the effect that depression itself and some of these risk factors may have had vs the contribution of the medication.
They also point out that the study cannot fully address situations in which patients begin treatment with antidepressants but do not respond to treatment, and that these patients may represent the highest-risk mortality group."
Arch Intern Med. 2009;169: 2128-213;2140-2141.
In contrast, compared with women who did not use antidepressants, those using SSRIs had a 45% increased relative risk of incidence stroke and a 32% increased risk of death in models stratified on propensity. TCA use in turn was associated with a 67% higher relative risk for all-cause death. The TCAs also increase stroke risk, but not significantly so.
Depression is still a much more established risk factor for cardiovascular disease (CVD) than antidepressants, so it's not as though not taking an antidepressant removes the risk because then you have untreated depression, which itself is risky. But if a woman is concerned about taking medication, there are alternative treatments for depression, such as cognitive behavioral therapy, which can be effective.
A key question is whether the association between antidepressant use and CV morbidity and mortality is truly related to drug exposure or to underlying differences in other CV risk factors, including depression....the propensity score used in this study did help control for risk factors that could have explained differences in CV outcomes between antidepressant users and nonusers,"but you can't fully tease out the effect that depression itself and some of these risk factors may have had vs the contribution of the medication.
They also point out that the study cannot fully address situations in which patients begin treatment with antidepressants but do not respond to treatment, and that these patients may represent the highest-risk mortality group."
Arch Intern Med. 2009;169: 2128-213;2140-2141.