Long-term use of antidepressants may increase the risk of suffering and dying from heart disease, scientists say.
Researchers at the University of Bristol found that patients who had been taking the drugs for more than 10 years were up to twice as likely to be diagnosed with and die from heart disease.
About one in six adults in England and one in five in the US take the drugs, which are thought to raise levels of mood-enhancing chemicals in the brain.
Despite the finding, academics today urged the millions of people who take the pills not to panic and insisted they were still safe to take.
The link they detected may be because depression itself increases the risk of heart problems, rather than the drugs themselves.
Researchers at the University of Bristol found that those who had been taking the drugs for more than 10 years were more likely to be diagnosed with and die from heart disease.
The team, led by Dr. Narinder Bansal, compared the health of those taking antidepressants with that of those not taking them over a 10-year period. They examined eight types of the drug, all of which are doled out by the NHS. These included selective serotonin reuptake inhibitors (SSRIs), citalopram (top image), sertraline (second image), fluoxetine, and paroxetine. Around eight in 10 people taking antidepressants in the UK take one of these medicines.
WHAT IS DEPRESSION?
While it’s normal to feel depressed from time to time, people with depression can feel persistently unhappy for weeks or months.
Depression can affect anyone at any age and is quite common: about one in ten people are likely to experience it at some point in their life.
Depression is a genuine health condition that people cannot just ignore or ‘snap out of’.
Symptoms and effects vary, but can include feeling constantly upset or hopeless, or losing interest in things you used to enjoy.
It can also cause physical symptoms such as sleep problems, tiredness, lack of appetite or sexual desire, and even physical pain.
In extreme cases it can lead to suicidal thoughts.
Traumatic events can trigger it, and people with a family history may be at higher risk.
It’s important to see a doctor if you think you or someone you know has depression, as it can be managed with lifestyle changes, therapy, or medication.
Source: NHS Options
To determine whether antidepressant use affected heart health, the researchers examined data on 220,121 people aged 40 to 69 in the UK Biobank, a database containing the health records of half a million Britons.
The team, led by Dr. Narinder Bansal, compared the health of those taking antidepressants with that of those not taking them over a 10-year period.
They examined eight types of the drug, all of which are doled out by the NHS.
These included selective serotonin reuptake inhibitors (SSRIs), citalopram, sertraline, fluoxetine, and paroxetine.
Around eight in 10 people taking antidepressants in the UK take one of these medicines.
They also looked at four other antidepressants: mirtazapine, venlafaxine, duloxetine and trazodone.
The results, published in the British Journal of Psychiatry Open, show that those taking SSRIs were 34 percent more likely to develop heart disease, compared to those not taking antidepressants.
Users were nearly twice as likely to die from cardiovascular disease and 73 percent more likely to die prematurely from any cause.
For those taking the other four antidepressants, the risks were about double that of those not taking them.
The team also found that antidepressants, particularly SSRIs, were associated with a 23 percent to 32 percent lower risk of developing high blood pressure or diabetes. However, they noted that more research was needed on this finding.
The researchers said: ‘Antidepressants, and especially SSRIs, may have a good short-term safety profile but are associated with long-term adverse outcomes.
“This is important because most of the substantial increase in prescribing over the past 20 years or more is due to long-term repeat prescribing.”
However, Dr Bansal urged people not to suddenly stop taking their medication, advising them to speak to their GP if they are concerned.
He noted that the researchers took into account a wide range of risk factors, including that people with depression are more likely to be overweight, smoke and exercise less.
But Dr. Bansal said it’s “difficult to completely control the effects of depression.”
“This makes it difficult to completely separate the effects of depression from the effects of medication,” he said.
For example, those taking all four non-SSRI antidepressants “may have more severe depression,” which could explain their higher rates of ill health.
Dr Bansal added: “Further research is needed to assess whether the associations we have seen are genuinely due to the drugs and, if so, why that might be.”
“In the meantime, our message to clinicians is that long-term prescribing of antidepressants may not be harmless.”
He called for “proactive cardiovascular monitoring” in patients taking long-term antidepressants, “since both have been associated with higher risks.”
NHS figures show that 8.3 million patients in England were prescribed antidepressants last year, a six percent increase from 7.9 million a year earlier.
Antidepressant prescriptions among adolescents increased by a quarter in England in 2020 compared to 2016. The greatest growth was seen among 13-19 year olds, where prescription rates increased by about a third.
Young adults, who are often leaving home for the first time and starting their careers, also saw antidepressant prescription rates rise by about 40 percent.
In 2019, research that analyzed around 1,000 existing studies, published in JAMA Psychiatry, concluded that antidepressants are generally safe.
Professor Glyn Lewis, a psychiatrist at University College London, said people should not be “alarmed or concerned” by the findings, or stop taking their medication.
He said the study couldn’t conclude whether depression increased health risks or antidepressant use.
“There is a lot of evidence, from other research, that depression is associated with an increase in cardiovascular disease,” he said.
“Clearly, there are behavioral things (associated with depression), where people may not take care of themselves, and there may also be hormonal changes and metabolic changes that could increase the risk of long-term physical illness.
“Without a (randomized controlled trial), it’s always going to be very, very difficult to make any inferences about whether it’s antidepressants or depression that leads to these kinds of associations.”
Professor David Osborn, a psychiatrist at UCL, said: “We have known that depression and anxiety are associated with elevated rates of cardiovascular disease for many years.”
“This explains the findings of this interesting article, but there is no evidence here for a causal role of antidepressants. Proving causality would require more elaborate research methods.
Professor Martin Marshall, President of the Royal College of GPs, said: “Existing evidence shows that antidepressants can be an effective treatment for the distressing and often debilitating symptoms of anxiety and depression when used appropriately.”
‘GPs are highly trained to have open and sensitive conversations with their patients, and when discussing mental health issues, they will consider various treatment options based on the patient’s unique needs, and if they prescribe antidepressants, it will generally be at the lowest dose. low and for the shortest amount of time.
“This is an interesting study and, as the authors describe, more research is needed in this area.
“However, it is very important that patients do not stop taking their prescribed antidepressants as a result of this research, but if they are concerned they should discuss it at their next medication review.”