SSRIs and SNRIs associated with increased morbidity and mortality in older adults with COPD, study results show

New use of serotonergic antidepressants is associated with small, but significant, increases in rates of respiratory-related morbidity and mortality among older adults with chronic obstructive pulmonary disorder (COPD), a retrospective study has shown^[1]
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The researchers aimed to evaluate the relationship between new selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine inhibitor (SNRI) drug use and respiratory-related morbidity and mortality in 131,718 adults aged 66 years and older, with diagnosed COPD. Data were collected for the period April 2008 to March 2014.

New use was defined as receipt of any SSRI or SNRI drug between April 2008 and December 2013 without any use during the year prior. In the control group were individuals who had not used any SSRI or SNRI drugs between April 2008 and December 2013.

It was found that SSRI/SNRI users had a 15% higher rate of hospitalisation for COPD or pneumonia and a 13% increased risk of an emergency department visit for COPD or pneumonia than non-users. Furthermore, SSRI/SNRI users had a 26% increased risk of COPD or pneumonia-related mortality and a 20% greater risk of all-cause mortality than non-users.

According to the study report, which was published in European Respiratory Journal (26 June 2018), depression and anxiety frequently occur in COPD and affect upwards of 70–80% of individuals.

SSRIs and SNRIs are recommended as first-line pharmacotherapy for major depression and generalised anxiety disorder; however, the researchers said the few clinical trials conducted with individuals with COPD have not clearly demonstrated that they are effective for depression and anxiety in this population.

There is also concern that they could lead to respiratory harm through several biological mechanisms, for example by promoting sleepiness, which may lead to respiratory depression, causing vomiting, which may lead to aspiration, and decreasing immune cell quantity and function.

The researchers said that their findings should “prompt prescribers to consider the potential for increased respiratory-related morbidity and mortality in SSRI/SNRI prescribing decision making”.