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Table 2 Unadjusted and adjusted hazard ratios for six adverse outcomes (falls, fracture, upper gastrointestinal bleed, road traffic accident, adverse drug reaction, and all-cause mortality) by antidepressant class compared with periods of non-use of antidepressants over 5 years follow-up

From: Antidepressant use and risk of adverse outcomes in people aged 20–64 years: cohort study using a primary care database

    Unadjusted analysis Adjusted analysisb
Antidepressant class No of eventsa Person-yearsa Hazard ratio 95% CI Hazard ratio 95% CI P
Falls
 No current use 2493 558,933 1.00   1.00   
 TCAs 298 40,260 1.79 (1.58–2.04) 1.36 (1.19–1.54) < 0.001
 SSRIs 1494 221,813 1.62 (1.52–1.73) 1.48 (1.39–1.59) < 0.001
 Other antidepressants 189 27,678 1.64 (1.42–1.89) 1.43 (1.23–1.66) < 0.001
 Combined antidepressants 37 4121 2.03 (1.48–2.78) 1.61 (1.16–2.22) 0.004
Fracture
 No current use 2759 510,172 1.00   1.00   
 TCAs 205 37,309 1.04 (0.90–1.20) 0.92 (0.80–1.06) 0.26
 SSRIs 1466 204,592 1.35 (1.26–1.44) 1.30 (1.21–1.39) < 0.001
 Other antidepressants 195 25,164 1.43 (1.24–1.65) 1.28 (1.11–1.48) 0.001
 Combined antidepressants 29 3759 1.39 (0.94–2.06) 1.22 (0.82–1.81) 0.32
Upper GI bleed
 No current use 588 570,654 1.00   1.00   
 TCAs 79 41,295 1.83 (1.45–2.29) 1.43 (1.13–1.81) 0.003
 SSRIs 300 226,336 1.21 (1.05–1.39) 1.16 (1.00–1.33) 0.045
 Other antidepressants 50 28,102 1.74 (1.31–2.31) 1.35 (1.00–1.82) 0.050
 Combined antidepressants 12 4245 2.65 (1.49–4.69) 2.13 (1.19–3.79) 0.010
Road traffic accident
 No current use 2343 546,915 1.00   1.00   
 TCAs 154 39,929 0.87 (0.72–1.05) 0.97 (0.80–1.17) 0.72
 SSRIs 929 218,137 0.97 (0.89–1.05) 1.03 (0.95–1.12) 0.47
 Other antidepressants 120 27,221 1.01 (0.84–1.22) 1.08 (0.90–1.30) 0.41
 Combined antidepressants 18 4063 1.00 (0.64–1.56) 1.12 (0.71–1.76) 0.62
Adverse drug reaction
 No current use 432 571,401 1.00   1.00   
 TCAs 122 41,380 3.11 (2.50–3.87) 2.69 (2.15–3.37) < 0.001
 SSRIs 396 226,577 1.88 (1.62–2.19) 1.75 (1.50–2.04) < 0.001
 Other antidepressants 70 28,197 3.03 (2.29–4.01) 2.81 (2.11–3.75) < 0.001
 Combined antidepressants 11 4257 3.29 (1.81–5.97) 2.92 (1.60–5.35) 0.001
All-cause mortality
 No current use 1541 575,623 1.00   1.00   
 TCAs 326 41,807 2.89 (2.54–3.29) 1.92 (1.68–2.19) < 0.001
 SSRIs 990 228,233 1.63 (1.50–1.78) 1.38 (1.26–1.51) < 0.001
 Other antidepressants 196 28,487 2.61 (2.24–3.03) 1.74 (1.48–2.06) < 0.001
 Combined antidepressants 41 4299 3.62 (2.69–4.88) 2.19 (1.60–3.00) < 0.001
  1. aBased on numbers in adjusted analysis (patients with missing values for confounding variables were excluded from the adjusted analyses – during 5 years follow-up, 141 of these patients had falls, 142 had fractures, 37 had upper gastrointestinal bleeds, 126 had road traffic accidents, 27 had adverse drug reactions and 87 died)
  2. bAdjusted for age, sex, year of diagnosis of depression, severity of depression, deprivation, smoking status, alcohol intake, ethnic group (white/not recorded or non-white), coronary heart disease, diabetes, hypertension, cancer, epilepsy/seizures, hypothyroidism, osteoarthritis, asthma/chronic obstructive airways disease, stroke/TIA, rheumatoid arthritis, osteoporosis, liver disease, renal disease, obsessive-compulsive disorder, statins, NSAIDS, aspirin, antihypertensive drugs, anticonvulsants, hypnotics/anxiolytics, oral contraceptives, hormone replacement therapy, antipsychotics, bisphosphonates, anticoagulants; fracture outcome also adjusted for falls
  3. GI gastrointestinal, SSRIs selective serotonin reuptake inhibitors, TCAs tricyclic and related antidepressants
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