Comparative Risk of Ventricular Arrhythmia and Sudden Cardiac Death Across Antidepressants in Patients with Depressive Disorders
Journal
Journal of Clinical Psychopharmacology
Journal Volume
37
Journal Issue
1
Pages
32-39
Date Issued
2017
Author(s)
Abstract
Objective We aimed to evaluate the risk of ventricular arrhythmia (VA) and/or sudden cardiac death (SCD) associated with antidepressant use. Methods A cohort study was conducted using data from Taiwan's National Health Insurance Research Database from 2001 to 2012. A total of 793,460 new antidepressant users with depressive disorders were enrolled in the study. Outcomes were defined as the first principal diagnosis of VA or SCD in the emergency department or hospital discharge records. Cox proportional hazards models with stratification of propensity score deciles were used to evaluate the relative risk of VA/SCD for antidepressants compared with selective serotonin reuptake inhibitors (SSRIs). Results A total of 245 VA/SCD events occurred. The incidence rate of VA/SCD among antidepressant users was 1.5 per 1000 person-years (95% confidence interval [CI], 1.3-1.7). Compared with SSRIs, the risk of VA/SCD was significantly lower for tricyclic or tetracyclic antidepressant (TCAs) (adjusted hazards ratio [aHR], 0.54; 95% CI, 0.36-0.83), but not other antidepressant classes. However, use of moderate-to high-dose TCAs carried a higher risk than low-dose TCAs (aHR, 4.37; 95% CI, 1.23-15.60). Antidepressant polypharmacy was associated with an increased risk of VA/SCD (aHR, 1.63; 95% CI, 1.07-2.49). Conclusions There was no difference in VA/SCD risk across antidepressant classes except that TCAs were associated with a lower risk than SSRIs. However, the observed comparative risk of TCAs might be attributable to low-dose TCA use, which is quite common in current clinical practice. It would be of importance to carry out further investigations to scrutinize the influence of antidepressants on VA/SCD. ? 2016 Wolters Kluwer Health, Inc. All rights reserved.
Subjects
antidepressant use; sudden cardiac death; ventricular arrhythmia
SDGs
Other Subjects
amfebutamone; amitriptyline; antiarrhythmic agent; anticoagulant agent; antidepressant agent; antilipemic agent; citalopram; clomipramine; digoxin; diuretic agent; dosulepin; doxepin; duloxetine; escitalopram; fluoxetine; flupentixol; fluvoxamine; imipramine; inotropic agent; maprotiline; melitracen; milnacipran; mirtazapine; moclobemide; nitric acid derivative; paroxetine; sertraline; trazodone; unindexed drug; venlafaxine; antidepressant agent; tricyclic antidepressant agent; adult; anxiety disorder; Article; cohort analysis; controlled study; data base; depression; drug dose comparison; drug megadose; drug safety; drug use; emergency ward; female; hazard ratio; heart arrest; heart ventricle arrhythmia; heart ventricle fibrillation; hospital discharge; human; incidence; low drug dose; major clinical study; male; medical record; mental patient; national health insurance; outcome assessment; paroxysmal tachycardia; polypharmacy; priority journal; propensity score; proportional hazards model; psychopharmacotherapy; risk assessment; risk factor; sudden cardiac death; Taiwan; young adult; aged; case report; chemically induced; depression; heart ventricle fibrillation; heart ventricle flutter; middle aged; sudden cardiac death; very elderly; Adult; Aged; Aged, 80 and over; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Death, Sudden, Cardiac; Depressive Disorder; Female; Humans; Male; Middle Aged; Taiwan; Ventricular Fibrillation; Ventricular Flutter; Young Adult
Type
journal article