Dec 28 2009 (MEDSCAPE) – Pam Harrison reports that “postmenopausal women taking either a tricyclic antidepressant (TCA) or a selective serotonin-reuptake inhibitor (SSRI) appear to be at increased risk for all-cause mortality, and SSRI users seem to be at increased risk for hemorrhagic and fatal stroke, although the absolute event risks are low, according to an analysis from the Women’s Health Initiative (WHI) study.”
In an article published in the December issue of the Archives of Internal Medicine, Jordan Smoller, MD, from Massachusetts General Hospital, Boston, and colleagues report that new use of either a TCA or an SSRI during a mean follow-up of 5.9 years was not significantly associated with an increased risk for coronary heart disease (CHD) in this large prospective cohort of postmenopausal women.
In contrast, compared with women who did not use antidepressants, “those using SSRIs had a 45% increased relative risk of incidence stroke and a 32% increased risk of death in models stratified on propensity and adjusted for multiple covariates,” the investigators report. TCA use in turn was associated with a 67% higher relative risk for all-cause death (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.33 – 2.09). The TCAs also increase stroke risk, but not significantly so.
“Depression is still a much more established risk factor for cardiovascular disease (CVD) than antidepressants, so it’s not as though not taking an antidepressant removes the risk because then you have untreated depression, which itself is risky,” Dr. Smoller told Medscape Psychiatry. “But if a woman is concerned about taking medication, there are alternative treatments for depression, such as cognitive behavioral therapy, which can be effective.”