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July 23, 2017

During an average of eight years follow-up there were 1,434 events related to CVD, of which 26.2% were fatal. Of the study participants, 2.2%, 2% and 0.7% reported taking tricyclic anti-depressants, SSRIs or other antidepressants respectively. After adjusting for various confounding factors, including indicators of mental illness, the researchers found there was a 35% increased risk of CVD associated with tricyclic anti-depressants. The use of SSRIs was not associated with any increased risk of CVD, nor did the researchers find any significant associations between anti-depressant use and deaths from any cause.

Dr Hamer said: "Our findings suggest that there is an association between the use of tricyclic anti-depressants and an increased risk of CVD that is not explained by existing mental illness. This suggests that there may be some characteristic of tricyclics that is raising the risk. Tricyclics are known to have a number of side effects; they are linked to increased blood pressure, weight gain and diabetes and these are all risk factors for CVD."

He continued: "It is important that patients who are already taking anti-depressants should not cease taking their medication suddenly, but should consult their GPs [primary care physicians] if they are worried. There are two important points to be made. First, tricyclics are the older generation of anti-depressant medicines and we found no excess risk with the newer drugs (SSRIs). Secondly, people taking the anti-depressants are also more likely to smoke, be overweight, and do little or no physical activity - by giving up smoking, losing weight, and becoming more active a person can reduce their risk of CVD by two to three-fold, which largely out-weighs the risks of taking the medications in the first place. In addition, physical exercise and weight loss can improve symptoms of depression and anxiety.

"Our findings suggest that clinicians should be cautious about prescribing anti-depressants and should also consider lifestyle advice, such as smoking cessation, exercise and sensible alcohol intake."

Source: University College London