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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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BMC Medicine

ISSN: 1741-7015

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