Journal Article

Safety of antidepressants in a primary care cohort of adults with obesity and depression

Khunti, Kamlesh, Morriss, Richard, Tyrer, Freya, Zaccardi, Francesco

2021

Overview

Obesity, depressive disorders and antidepressant drugs are associated with increased mortality, cardiovascular disease, diabetes, fractures and falls. We explored outcomes associated with the most commonly prescribed antidepressants in overweight or obese people with depression. We identified a cohort of overweight or obese adults (≥18 years) in primary care from the UK Clinical Practice Research Datalink, linked with hospital and mortality data, between 1 January 2000 and 31 December 2016 who developed incident depression to January 2019. Cox proportional hazards models and 99% confidence intervals were used to estimate hazard ratios (HR) for mortality, cardiovascular disease, diabetes, and falls/fractures associated with exposure to selective serotonin reuptake inhibitors (SSRIs), tricyclic (TCA)/other, combination antidepressants, citalopram, fluoxetine, sertraline, amitriptyline and mirtazapine, adjusting for potential confounding variables. In 519,513 adults, 32,350 (9.2 per 1,000 years) displayed incident depression and 21,436 (66.3%) were prescribed ≥1 antidepressant. Compared with no antidepressants, all antidepressant classes were associated with increased relative risks of cardiovascular disorders [SSRI HR: 1.32 (1.14-1.53), TCA/Other HR: 1.26 (1.01-1.58)], and diabetes (any type) [SSRI HR: 1.28 (1.10-1.49), TCA/Other: 1.52 (1.19-1.94)]. All commonly prescribed antidepressants except citalopram were associated with increased mortality compared with no antidepressants. However, prescription ≥1 year of ≥40mg citalopram was associated with increased mortality and falls/fractures and ≥1 year 100mg sertraline with increased falls/fractures. In overweight/obese people with depression, antidepressants may be overall and differentially associated with increased risks of some adverse outcomes. Further research is required to exclude indication bias and residual confounding.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Antidepressants / Biology and Life Sciences / Bipolar disorder / Body weight / Cardiovascular diseases / Complications and side effects / Computer programs / Confidence intervals / Depression, Mental / Deprivation / Diabetes / Diabetes mellitus / Diagnosis / Dosage and administration / Drug therapy / Editing / Funding / Gender / Health care / Health risks / Kidney diseases / Medicine and Health Sciences / Mental depression / Mental health / Methodology / Minority & ethnic groups / Mortality / Obesity / Overweight / Overweight persons / Patient outcomes / Psychological aspects / Psychotropic drugs / Research facilities / Safety and security measures / Socioeconomic factors / Socioeconomics / Software / Statistical analysis / Visualization