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05-12-2010 | Cardiology | Article

Tricyclic antidepressants may raise CVD risk


Free abstract

MedWire News: Use of tricyclic antidepressants (TCAs) - first-generation antidepressants - may increase patients' cardiovascular disease (CVD) risk by around one third, according to results from a Scottish study.

Second-generation antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), do not appear to carry the same risk, however.

The study, published in the European Heart Journal, consisted of 14,784 Scottish patients with no known CVD history.

Mark Hamer, from University College London in the UK, and colleagues monitored the rate of CVD events (CVD-related death, nonfatal myocardial infarction, stroke, heart failure, and coronary interventions) over a follow-up period of 8 years.

In all, 4.9% of patients reported antidepressant use, with a rate of 2.2%, 2.0%, and 0.7% for TCAs, SSRIs, and other antidepressants, respectively.

Over the follow-up period, 1434 CVD events occurred, with 100 of these occurring in patients taking antidepressants.

Hamer and team found that patients taking TCAs had a higher rate of CVD events than those taking any other antidepressants, at 18%, 10%, and 11% among patients taking TCAs, SSRIs, and other antidepressants, respectively.

After adjustment for confounding variables, such as history of psychiatric inpatient stay and socioeconomic group, the researchers observed a significant 1.35-fold higher risk for CVD events among patients taking TCAs than patients not taking any antidepressants (95% confidence interval, 1.03-1.77).

No other type of antidepressant significantly elevated CVD event risk compared with no antidepressant use.

Hamer and team comment: "On the basis of our findings, the association between antidepressant use and CVD risk is partly independent of psychiatric symptoms which suggests that there may be some characteristic of TCA that is raising CVD risk.

"Equally it is plausible that an elevated rate of CVD of 35% could be explained by residual confounding due to unmeasured or unknown risk factors."

They conclude that clinicians should exercise caution when prescribing antidepressants.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Lauretta Ihonor

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