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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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