Status
Completed
Title
Safety of antidepressants in people aged less than 65: cohort study using a large primary care database.
What were the objectives of the study?
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 was the research 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
Lead Applicant Organisation Name
Sponsor
Oxford
Location of research
Oxford and Nottingham
Date on which research approved
01-Jan-2013
Project reference ID
R59
Generic ethics approval reference
18/EM/0400
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).
Public Benefit Statement
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
- Potential risks of antidepressants (7 May 2018)
- Adverse effects of antidepressants in younger adults (20 April 2018)
- Antidepressant Types Linked to Different Adverse Outcomes in Adults with Depression (2 April 2018)
- SSRI antidepressants not associated with an increased risk of cardiovascular conditions (22 March 2016)
- Some antidepressants may be linked with higher rates of suicide and self-harm, research finds (20 February 2015)
Access Type
Trusted Research Environment (TRE)