Table 4.
Adjusted hazard ratios for arrhythmia, myocardial infarction, and stroke or transient ischaemic attack by antidepressant class, dose, and individual drug over first year of follow-up
| Arrhythmia | Myocardial infarction | Stroke/TIA | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No of events | Adjusted hazard ratio† (95% CI) | P value | No of events | Adjusted hazard ratio† (95% CI) | P value | No of events | Adjusted hazard ratio† (95% CI) | P value | ||||
| Antidepressant class | ||||||||||||
| No current use | 127 | 1.00 | - | 90 | 1.00 | - | 113 | 1.00 | - | |||
| TCAs | 39 | 1.16 (0.81 to 1.67) | 0.42 | 25 | 1.09 (0.72 to 1.66) | 0.68 | 33 | 1.01 (0.69 to 1.49) | 0.94 | |||
| SSRIs | 141 | 0.86 (0.66 to 1.11) | 0.24 | 63 | 0.58 (0.42 to 0.79) | 0.001 | 118 | 0.83 (0.63 to 1.09) | 0.18 | |||
| Other antidepressants | 20 | 1.33 (0.84 to 2.12) | 0.23 | 9 | 0.81 (0.42 to 1.58) | 0.54 | 16 | 1.15 (0.69 to 1.90) | 0.59 | |||
| Combined antidepressants | 5 | 3.45 (1.24 to 9.57) | 0.02 | 2 | 1.68 (0.43 to 6.65) | 0.46 | 1 | 0.69 (0.10 to 4.96) | 0.72 | |||
| Antidepressant class and dose categories | ||||||||||||
| No current use | 127 | 1.00 | - | 90 | 1.00 | - | 113 | 1.00 | - | |||
| TCAs: | ||||||||||||
| ≤0.5 DDD | 21 | 0.98 (0.62 to 1.55) | 0.92 | 12 | 0.86 (0.47 to 1.56) | 0.62 | 18 | 0.87 (0.54 to 1.41) | 0.58 | |||
| >0.5 DDD/≤1.0 DDD | 10 | 1.76 (0.92 to 3.35) | 0.09 | 4 | 0.93 (0.35 to 2.50) | 0.89 | 8 | 1.36 (0.66 to 2.78) | 0.41 | |||
| >1.0 DDD | 4 | 1.22 (0.46 to 3.24) | 0.69 | 3 | 1.29 (0.41 to 4.04) | 0.66 | 4 | 1.26 (0.47 to 3.38) | 0.65 | |||
| Test for trend‡ | - | - | 0.83 | - | - | 0.47 | - | - | 0.23 | |||
| SSRIs: | ||||||||||||
| ≤0.5 DDD | 11 | 0.95 (0.52 to 1.72) | 0.85 | 5 | 0.76 (0.30 to 1.92) | 0.56 | 7 | 0.73 (0.34 to 1.56) | 0.42 | |||
| >0.5 DDD/≤1.0 DDD | 105 | 0.81 (0.62 to 1.08) | 0.15 | 43 | 0.52 (0.37 to 0.73) | <0.001 | 90 | 0.81 (0.61 to 1.09) | 0.16 | |||
| >1.0 DDD | 21 | 1.07 (0.65 to 1.76) | 0.79 | 11 | 0.75 (0.41 to 1.36) | 0.34 | 17 | 0.99 (0.59 to 1.67) | 0.98 | |||
| Test for trend‡ | - | - | 0.57 | - | - | 0.42 | - | - | 0.47 | |||
| Others: | ||||||||||||
| ≤0.5 DDD | 3 | 1.06 (0.34 to 3.32) | 0.93 | 2 | 0.95 (0.23 to 3.96) | 0.95 | 4 | 1.58 (0.57 to 4.35) | 0.38 | |||
| >0.5 DDD/≤1.0 DDD | 13 | 1.65 (0.91 to 2.98) | 0.10 | 3 | 0.53 (0.17 to 1.60) | 0.26 | 7 | 0.95 (0.45 to 1.98) | 0.88 | |||
| >1.0 DDD | 2 | 0.80 (0.20 to 3.20) | 0.76 | 2 | 1.04 (0.26 to 4.17) | 0.95 | 4 | 1.76 (0.66 to 4.73) | 0.26 | |||
| Test for trend‡ | - | - | 0.51 | - | - | 0.40 | - | - | 0.72 | |||
| Antidepressant drug | ||||||||||||
| No current use | 130 | 1.00 | 90 | 1.00 | 113 | 1.00 | ||||||
| TCAs: | ||||||||||||
| Amitriptyline | 18 | 1.15 (0.69 to 1.94) | 0.59 | 8 | 0.75 (0.37 to 1.55) | 0.44 | 15 | 1.00 (0.59 to 1.70) | 1.00 | |||
| Dosulepin | 8 | 0.73 (0.35 to 1.50) | 0.39 | 8 | 1.07 (0.53 to 2.18) | 0.85 | 12 | 1.12 (0.63 to 1.98) | 0.70 | |||
| Lofepramine | 8 | 2.13 (1.05 to 4.33) | 0.04 | 8 | 3.07 (1.50 to 6.26) | 0.002 | 4 | 1.15 (0.43 to 3.11) | 0.78 | |||
| Trazodone | 3 | 1.72 (0.53 to 5.56) | 0.36 | 1 | 0.73 (0.10 to 5.19) | 0.76 | 1 | 0.56 (0.08 to 3.72) | 0.55 | |||
| SSRIs: | ||||||||||||
| Citalopram | 56 | 0.79 (0.57 to 1.10) | 0.17 | 27 | 0.59 (0.39 to 0.91) | 0.017 | 43 | 0.73 (0.51 to 1.05) | 0.09 | |||
| Escitalopram | 9 | 1.01 (0.47 to 2.16) | 0.99 | 4 | 0.67 (0.25 to 1.82) | 0.43 | 5 | 0.63 (0.26 to 1.53) | 0.31 | |||
| Fluoxetine | 48 | 0.79 (0.55 to 1.13) | 0.19 | 18 | 0.44 (0.27 to 0.72) | 0.001 | 56 | 1.06 (0.76 to 1.50) | 0.72 | |||
| Paroxetine | 13 | 1.10 (0.61 to 1.99) | 0.74 | 3 | 0.38 (0.12 to 1.22) | 0.10 | 7 | 0.63 (0.28 to 1.38) | 0.25 | |||
| Sertraline | 15 | 1.21 (0.71 to 2.07) | 0.48 | 10 | 1.18 (0.64 to 2.20) | 0.59 | 7 | 0.63 (0.30 to 1.35) | 0.24 | |||
| Others: | ||||||||||||
| Mirtazapine | 8 | 1.20 (0.57 to 2.53) | 0.62 | 5 | 0.91 (0.37 to 2.24) | 0.84 | 12 | 1.85 (1.01 to 3.37) | 0.04 | |||
| Venlafaxine | 11 | 1.64 (0.88 to 3.08) | 0.12 | 4 | 0.89 (0.33 to 2.39) | 0.81 | 3 | 0.51 (0.16 to 1.57) | 0.24 | |||
| All other antidepressants | 3 | 0.90 (0.30 to 2.69) | 0.85 | 1 | 0.46 (0.06 to 3.35) | 0.44 | 2 | 0.64 (0.15 to 2.63) | 0.53 | |||
| Combined antidepressants | 5 | 3.44 (1.24 to 9.55) | 0.02 | 2 | 1.68 (0.43 to 6.64) | 0.46 | 1 | 0.70 (0.10 to 4.97) | 0.72 | |||
SSRI=selective serotonin reuptake inhibitor; TCA=tricyclic and related antidepressant; TIA=transient ischaemic attack.
*Based on numbers in adjusted analysis.
†Adjusted for age, sex, year of diagnosis of depression, severity of depression, deprivation, smoking status, alcohol intake, ethnic group (white/not recorded or non-white), coronary heart disease, diabetes, hypertension, cancer, epilepsy/seizures, hypothyroidism, osteoarthritis, asthma/chronic obstructive airways disease, stroke/transient ischaemic attack (except for the stroke/TIA outcome), rheumatoid arthritis, osteoporosis, liver disease, renal disease, obsessive-compulsive disorder, statins, non-steroidal anti-inflammatory drugs, aspirin, antihypertensives, anticonvulsants, hypnotics/anxiolytics, oral contraceptives, hormone replacement therapy, antipsychotics, bisphosphonates, anticoagulants.
‡Test for trend uses continuous values of dose.