No Sign of Cardiovascular Risks With SSRI Antidepressants in Younger Patients

Reassuring new registry data suggest not only do selective serotonin reuptake inhibitors (SSRIs) not increase the risk of cardiovascular events in patients younger than 65, but also that certain versions of the drugs might actually decrease MI risk over time. That’s despite prior research suggesting patients with depression who are taking SSRIs are at a higher risk for adverse cardiovascular events.

In 2011, researchers led by Carol Coupland, PhD (University of Nottingham, England), found an association between SSRI use and increased risk of heart attack and stroke in a cohort of patients older than 65. This time around, she told TCTMD in an email, “we wanted to ascertain whether these findings were similar in a younger age group.”

In their latest study, published online this week in BMJ, they reviewed cardiovascular events in 238,963 patients aged 20 to 64 who were first diagnosed with depression in the United Kingdom between January 2000 and July 2011. Among these people, taking SSRIs did not affect the risk of arrhythmia or stroke/TIA over 5 years (P = NS for both).

Coupland said this lack of effect in the younger cohort may be due to their lack of comorbidities. By comparison, the increased events among the older cohort studied previously may speak to the “high prevalence of other illnesses and concurrent use of other drugs in older people,” she suggested.

Interestingly, the younger patients treated with SSRIs had a slightly reduced risk of MI over 5 years (adjusted RR 0.58; 95% CI 0.42-0.79) compared with those on no antidepressants. Specifically, fluoxetine was associated with the greatest reduction in MI risk, while lofepramine was linked to a slightly increased risk. The latter drug is “generally considered to be safer than other tricyclic and related antidepressants,” Coupland said, so there might be indication bias at play, with lofepramine perhaps “selectively prescribed to people at increased risk of cardiovascular events.”

It will be hard to know if these data will have any effect on prescribing patterns, Coupland said, “but antidepressant prescribing is increasing year on year,” and many patients are taking them for increasingly longer durations. “This study offers reassurance about their long-term use in people aged 20-64 in terms of cardiovascular effects,” she concluded.

• Coupland C, Hill T, Morriss R, 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.

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