QResearch

Antidepressants study in adults less than 65

Title

Safety of antidepressants in people aged less than 65: cohort study using a large primary care ​database.

What is the aim of the study and why is it important?

Antidepressants are one of the most commonly prescribed medications worldwide, and their use is increasing. There is some evidence that certain illnesses and harmful events could be caused by antidepressants, so the study was carried out to see whether taking antidepressants increased the risk of these illnesses and whether the risks were higher for some types of antidepressant.

How is the research being done?

The study used the QResearch database to identify a large group of nearly 240,000 people who had been diagnosed with depression between the ages of 20 to 64 and used data recorded on prescriptions they had received to find out what antidepressants they had been prescribed. Then people in the study who had new diagnoses of different illnesses and harmful events over the next five years were identified. These illnesses and harmful events included epilepsy, falls, fractures, suicide, self-harm, heart attacks, stroke, abnormal heart rhythms, sudden death, antidepressant poisoning, upper gastrointestinal bleeding, drug reactions, deaths. The data were analysed to compare risks of these events for different types of antidepressant.

Chief Investigator

Carol Coupland

Location of research

Oxford and Nottingham

Date on which research approved

01-Jan-2013

Project reference ID

R59

Are all data accessed are in anonymised form?

Yes

Brief summary of the dataset to be released (including any sensitive data)

See published protocol for full description of dataset. In summary, cohort of patients aged 20-64 between 2000 and 2011. Details of all prescriptions for antidepressants in patients in the cohort were extracted, including the date of each prescription, the type of antidepressant drug, the dose and total quantity prescribed. Prospectively recorded data information on adverse outcomes included the following recorded on GP or linked mortality records: all-cause mortality, suicide, attempted suicide/self-harm, sudden death, antidepressant overdose/poisoning, myocardial infarction, stroke/transient ischaemic attack, cardiac arrhythmia, epilepsy/seizures, upper gastrointestinal bleeding, falls, fractures, adverse drug reactions and motor vehicle crashes.

What were the main findings?

This study in people aged 20 to 64 found that some antidepressants seemed to be safer than others, but this depended on which illness or event was being looked at. For example the risks of suicide and self-harm were higher for certain types of antidepressant than for others, and the risks of epilepsy was increased for eight of the eleven most commonly prescribed antidepressant drugs. Commonly used antidepressants, known as ‘selective serotonin reuptake inhibitors’ (SSRIs), were not associated with an increased risk of cardiovascular conditions, such as heart attacks and strokes. All antidepressant drug classes were associated with significantly increased rates of falls. Selective serotonin reuptake inhibitors had higher rates of fracture than tricyclic and related antidepressants but lower mortality and adverse drug reaction rates than the other antidepressant drug classes.

Implications and Impact

This large study of antidepressant safety has provided information on the risks of a range of illnesses and harmful events for different antidepressant medications in people aged 20 to 64. The results show that the risks of certain illnesses and harmful events vary depending on the type of antidepressant prescribed. The risks and benefits of different antidepressants should be carefully considered and discussed when these drugs are prescribed.

Funding Source

The project was funded by the National Institute for Health Research (NIHR) School for Primary Care Research (project number 81).

Research Team

Carol Coupland, Trevor Hill, Julia Hippisley-Cox, Richard Morriss: University of Nottingham Michael Moore: University of Southampton Antony Arthur: University of East Anglia  

Publications

  • Antidepressant use and risk of adverse outcomes in people aged 20–64 years: cohort study using a primary care database
    Authors: Coupland CA, Hill T, Morriss R, Moore M, Arthur A, Hippisley-Cox J
    Ref: BMC Medicine 2018;16(1):36
    https://doi.org/10.1186/s12916-018-1022-x
  • Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using a primary care database
    Authors: Coupland CA, Hill T, Morriss R, Moore M, Arthur A, Hippisley-Cox J
    Ref: BMJ 2016;352:i1350
    http://www.bmj.com/content/bmj/352/bmj.i1350.full.pdf
  • Antidepressant use and risk of suicide and attempted suicide/self-harm in people aged 20 to 64: cohort study using a primary care database
    Authors: Coupland CA, Hill T, Morriss R, Arthur A, Moore M, Hippisley-Cox J
    Ref: BMJ 2015;350:h517
    http://www.bmj.com/content/350/bmj.h517
  • Antidepressant use and risk of epilepsy and seizures in people aged 20 to 64 years: cohort study using a primary care database
    Authors: Hill T, Coupland C, Morriss R, Moore MV, Hippisley-Cox J
    Ref: BMC Psychiatry 2015;15:315
    http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-015-0701-9
  • Safety of antidepressants in adults aged under 65: protocol for a cohort study using a large primary care database
    Authors: Coupland C, Morriss R, Arthur A, Moore M, Hill T, Hippisley-Cox J
    Ref: BMC Psychiatry 2013;13(1):135
    http://www.biomedcentral.com/1471-244X/13/135

Press Releases

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