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Table 6 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 no antidepressant treatment, over 1 year 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

421

93,760

1.00

 

1.00

  

 TCAs

87

16,178

1.33

(1.06–1.68)

1.05

(0.83–1.33)

0.69

 SSRIs

547

98,916

1.29

(1.12–1.48)

1.26

(1.10–1.45)

0.001

 Other antidepressants

44

8220

1.29

(0.96–1.74)

1.15

(0.84–1.57)

0.39

 Combined antidepressants

6

848

1.82

(0.88–3.76)

1.40

(0.64–3.06)

0.40

 Comparison between groupsc

      

0.42

Fracture

 No current use

484

85,735

1.00

 

1.00

  

 TCAs

74

14,901

0.92

(0.72–1.17)

0.81

(0.63–1.05)

0.11

 SSRIs

609

90,901

1.20

(1.06–1.37)

1.16

(1.02–1.33)

0.021

 Other antidepressants

62

7437

1.46

(1.12–1.90)

1.29

(0.99–1.68)

0.06

 Combined antidepressants

6

779

1.33

(0.60–2.95)

1.17

(0.53–2.59)

0.70

 Comparison between groupsc

      

0.030

Upper GI bleed

 No current use

108

95,101

1.00

 

1.00

  

 TCAs

34

16,409

1.74

(1.21–2.49)

1.53

(1.05–2.23)

0.025

 SSRIs

146

100,228

1.16

(0.91–1.50)

1.26

(0.97–1.63)

0.08

 Other antidepressants

28

8282

2.92

(1.93–4.43)

2.42

(1.56–3.76)

< 0.001

 Combined antidepressants

< 5

861

2.85

(0.91–8.90)

2.42

(0.80–7.28)

0.12

 Comparison between groupsc

      

0.006

Road traffic accident

 No current use

415

91,721

1.00

 

1.00

  

 TCAs

52

15,911

0.73

(0.52–1.02)

0.82

(0.58–1.14)

0.24

 SSRIs

442

96,813

1.03

(0.91–1.18)

1.07

(0.93–1.23)

0.35

 Other antidepressants

39

8037

1.11

(0.79–1.56)

1.16

(0.82–1.62)

0.41

 Combined antidepressants

< 5

832

0.77

(0.25–2.36)

0.84

(0.27–2.60)

0.76

 Comparison between groupsc

      

0.35

Adverse drug reaction

 No current use

91

95,252

1.00

 

1.00

  

 TCAs

62

16,444

2.99

(2.15–4.17)

2.73

(1.95–3.83)

< 0.001

 SSRIs

228

100,326

1.92

(1.49–2.45)

1.82

(1.41–2.34)

< 0.001

 Other antidepressants

29

8316

3.35

(2.13–5.28)

3.16

(1.99–5.03)

< 0.001

 Combined antidepressants

< 5

861

4.67

(1.70–12.85)

4.59

(1.66–12.71)

0.003

 Comparison between groupsc

      

0.005

All-cause mortality

 No current use

298

95,801

1.00

 

1.00

  

 TCAs

88

16,560

1.58

(1.23–2.04)

1.12

(0.86–1.46)

0.39

 SSRIs

408

100,907

1.22

(1.05–1.41)

1.09

(0.93–1.27)

0.29

 Other antidepressants

56

8380

2.01

(1.53–2.65)

1.39

(1.04–1.85)

0.024

 Combined antidepressants

8

868

2.77

(1.37–5.59)

1.81

(0.86–3.81)

0.12

 Comparison between groupsc

      

0.22

  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 four different drug groups including combined antidepressants but not 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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