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Table 3 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 selective serotonin reuptake inhibitors 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
 SSRIs 1494 221,813 1.00   1.00   
 TCAs 298 40,260 1.11 (0.97–1.26) 0.91 (0.80–1.05) 0.20
 Other antidepressants 189 27,678 1.01 (0.88–1.17) 0.96 (0.83–1.12) 0.62
 Combined antidepressants 37 4121 1.25 (0.91–1.72) 1.08 (0.78–1.50) 0.63
 No current use 2493 558,933 0.62 (0.58–0.66) 0.67 (0.63–0.72) < 0.001
 Comparison between groupsc        0.59
Fracture
 SSRIs 1466 204,592 1.00   1.00   
 TCAs 205 37,309 0.77 (0.67–0.89) 0.71 (0.61–0.82) < 0.001
 Other antidepressants 195 25,164 1.06 (0.91–1.24) 0.99 (0.85–1.15) 0.85
 Combined antidepressants 29 3759 1.03 (0.69–1.54) 0.94 (0.63–1.40) 0.77
 No current use 2759 510,172 0.74 (0.69–0.79) 0.77 (0.72–0.83) < 0.001
 Comparison between groupsc        < 0.001
Upper GI bleed
 SSRIs 300 226,336 1.00   1.00   
 TCAs 79 41,295 1.51 (1.20–1.91) 1.24 (0.97–1.57) 0.08
 Other antidepressants 50 28,102 1.44 (1.08–1.93) 1.17 (0.86–1.57) 0.32
 Combined antidepressants 12 4245 2.19 (1.23–3.92) 1.84 (1.03–3.30) 0.041
 No current use 588 570,654 0.83 (0.72–0.95) 0.86 (0.75–1.00) 0.045
 Comparison between groupsc        0.07
Road traffic accident
 SSRIs 929 218,137 1.00   1.00   
 TCAs 154 39,929 0.90 (0.74–1.09) 0.94 (0.77–1.14) 0.51
  Other antidepressants 120 27,221 1.05 (0.86–1.27) 1.05 (0.87–1.27) 0.63
 Combined antidepressants 18 4063 1.03 (0.66–1.62) 1.09 (0.69–1.72) 0.72
 No current use 2343 546,915 1.03 (0.95–1.12) 0.97 (0.89–1.05) 0.47
 Comparison between groupsc        0.84
Adverse drug reaction
 SSRIs 396 226,577 1.00   1.00   
 TCAs 122 41,380 1.65 (1.35–2.01) 1.54 (1.25–1.88) < 0.001
 Other antidepressants 70 28,197 1.61 (1.23–2.11) 1.61 (1.22–2.12) 0.001
 Combined antidepressants 11 4257 1.75 (0.96–3.16) 1.67 (0.92–3.04) 0.09
 No current use 432 571,401 0.53 (0.46–0.62) 0.57 (0.49–0.67) < 0.001
 Comparison between groupsc        < 0.001
All-cause mortality
 SSRIs 990 228,233 1.00   1.00   
 TCAs 326 41,807 1.77 (1.55–2.01) 1.39 (1.22–1.59) < 0.001
 Other antidepressants 196 28,487 1.59 (1.38–1.84) 1.26 (1.08–1.47) 0.003
 Combined antidepressants 41 4299 2.22 (1.64–2.99) 1.58 (1.16–2.17) 0.004
 No current use 1541 575,623 0.61 (0.56–0.67) 0.72 (0.66–0.79) < 0.001
 Comparison between groupsc        < 0.001
  1. aBased on numbers in adjusted analysis
  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. cComparison between the different drug classes including combined antidepressants but not including no current use
  4. GI gastrointestinal, SSRIs selective serotonin reuptake inhibitors, TCAs tricyclic and related antidepressants
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