Study Suggests SSRIs Do Not Increase Risk of Adverse Cardiovascular Outcomes

People with depression are more likely to develop cardiovascular disease and have a higher mortality rate than the general population, but whether antidepressants alter this risk remains unknown. A study published in the BMJ now suggests selective serotonin reuptake inhibitors (SSRIs) are not associated with an increased risk of adverse cardiovascular outcomes such as heart attack and stroke and may even decrease the risk of these events.

Researchers from the United Kingdom led a retrospective study of nearly 240,000 patients aged 20 to 64 who were first diagnosed with depression between January 2000 and July 2011. The authors tracked antidepressant prescriptions and diagnoses of myocardial infarction, stroke/transient ischemic attack, and arrhythmia during a five-year period following the initial depression diagnosis.

During the follow-up period, 209,476 (87.7%) patients received a total of 3,337,336 antidepressant prescriptions (71.3% of these prescriptions were for SSRIs), and there were 1,452 new diagnoses of arrhythmia, 772 new diagnoses of myocardial infarction, and 1,106 new diagnoses of stroke or transient ischemic attack.

The researchers found no evidence that SSRIs are associated with an increased risk of arrhythmia, myocardial infarction, or stroke/transient ischemic attack, but there was some indication that the medications are associated with a reduced risk of myocardial infarction and arrhythmia. Citalopram—an SSRI that has been found to cause dose-dependent QT interval prolongation—was not associated with arrhythmia, even at high doses (greater than or equal to 40 mg/day). In contrast, the risk of arrhythmia was increased during the first 28 days of taking tricyclic and related antidepressants.

“Prescription of antidepressants is a complex process, involving balancing of risks and benefits for different antidepressants and doses, accounting for severity of depression, and considering patients’ risk factors, comorbidities, and preferences,” the authors wrote. “These findings are reassuring in light of recent safety concerns about selective serotonin reuptake inhibitors.”

For related information, see the Psychiatric News article “Antidepressants May Help Improve Heart Health.”

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