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Tricyclic antidepressants ‘raise cardiovascular risk’

By Lilian Anekwe

GPs have been advised to consider alternatives to tricyclic antidepressants after a UK study of 15,000 patients showed those who took the drugs had a 35% greater risk of developing cardiovascular disease than those who did not.

The increase was apparent after adjusting for psychiatric symptoms and no increase was seen with SSRIs or other antidepressants, which the researchers say suggests tricyclics are truly raising CVD risk.

Researchers analysed data from the Scottish Health Survey involving 14,784 men and women over 35, initially without CVD, and linked data – including medication use - with records on hospital admissions and deaths over an average eight years follow up.

Almost 5% of patients reported the use of antidepressant medication, of which 2.2% were taking tricyclics, 2% SSRIs and 0.7% other antidepressants.

There was a 35% increased risk of cardiovascular disease associated with tricyclic use compared to patients on no medication, after adjusting for confounding factors.

Study leader Dr Mark Hamer, senior research fellow in epidemiology and public health at University College London told Pulse GPs should consider switching any patient on tricyclics to an alternative.

‘Tricyclics are also quite widely for headaches, migraines and other kinds of neurological pain. But the increased risk was not specific to what patients were being treated for. If there is an alternative option our data suggests GPs should look at it,' he said.

The study also found those taking antidepressants were more likely to smoke, be overweight and do little or no physical activity and Dr Hamer added: ‘By giving up smoking, losing weight, and becoming more active a person can reduce their risk of cardiovascular disease by two to three-fold, which largely outweighs the risks of taking the medications in the first place.'

Dr John Hague, a GPSI in mental health in Ipswich said: ‘NICE depression guidance is clear that GPs should consider SSRIs first line as drug therapy and there are alternatives for neuropathic pain - like gapapentin and pregabalin.'

The study did not look at antidepressant dose and Dr Hague said: ‘Whether the risk is dose-dependent, is an extremely important question and we need further research into it.

Often a dose of 40-50mg is used for chronic pain but for depression the dose is typically 125 or 150mg a day. If it does apply to low doses for chronic pain then I'd be concerned.'

European Heart Journal, 1 December

Tricyclic antidepressants 'raise cardiovascular risk'


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