Antidepressant use increases the risk of mortality and new cardiovascular events, according to a study published in Psychotherapy and Psychosomatics
The findings were the result of a meta-analysis which assessed studies examining the link between antidepressant, mortality and other co-morbidities, taken from PubMed, Embase and Google Scholar.
It was found that antidepressant use was associated with a 33% increased risk of mortality (hazard ratio [HR] = 1.33, 95% confidence interval [CI]: 1.14–1.55) and a 14% increased risk of cardiovascular events (HR = 1.14, 95% CI: 1.08–1.21), although it was found that antidepressant risk did not significantly affect risk for patients with existing cardiovascular problems, such as heart disease and diabetes.
The authors said the results support the hypothesis that antidepressants are harmful in the general population but less harmful in cardiovascular patients.
“We are very concerned by these results,” said Paul Andrews, lead author and associate professor at McMaster University. “They suggest that we shouldn’t be taking antidepressant drugs without understanding precisely how they interact with the body.”
The study explains the role of serotonin in many vital biological processes, including growth, development and reproduction. Therefore, selective serotonin re-uptake inhibitors (SSRIs), the most widely prescribed antidepressants, could potentially degrade many of these key adaptive processes.
And this is not restricted just to SSRIs; triclyclic antidepressants affect norepinephrine, which has an effect on the sympathetic nervous system, and dopamine, which has broad effects on the immune, endocrine and renal systems, among others.
“The findings highlight the urgent need for more rigorous investigations into the mortality effects of antidepressants,” the report said.
“They are too widely used to allow this basic question of safety to remain unanswered.”
The authors concluded that healthcare providers should take greater care in evaluating the relative costs and benefits of antidepressants for each individual patient, including an assessment of cardiovascular status.
 Maslej M, Bolker B, Russell M, et al. The mortality and myocardial effects of antidepressants are moderated by pre-existing cardiovascular disease: a meta-analysis. Psychother Psychosom 2017. doi: 10.1159/000477940