Association between angiotensin receptor blockers and suicide: nationwide population-based propensity score matching study

Lin, Shih‐Yi; Lin, Cheng‐Li; Lin, Cheng‐Chieh; Hsu, Wu‐Huei; Wang, I‐Kuan; Hsieh, Ming-Han; Hsu, Chung Y.; Kao, Chia‐Hung

doi:10.1016/j.jad.2020.07.106

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…With regard to ARBs, data in humans are currently very limited. Clinical reports and observational studies recently reported encouraging findings in psychotic patients; 105 , 106 protective effects of ARBs on cognition, 107 , 108 depression, and anxiety have also been reported (see Supplementary material online , Table S1 ). According to recent findings from a meta-analysis of 11 RCTs comparing ACEIs or ARBs versus either placebo or non-ACEI or non-ARBs, the use of ACEI or ARBs was significantly associated with improved mental health domains in adults (overall quality of life, positive wellbeing, mental and anxiety domains of quality of life).…”

Section: Renin-angiotensin System Modulatorsmentioning

confidence: 89%

Antihypertensive drugs and brain function: mechanisms underlying therapeutically beneficial and harmful neuropsychiatric effects

Carnovale

Perrotta

Baldelli

et al. 2022

Cardiovascular Research

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A bidirectional relationship exists between hypertension and psychiatric disorders, including unipolar and bipolar depression, anxiety, post-traumatic stress disorder (PTSD), psychosis, schizophrenia, mania, and dementia/cognitive decline. Repurposing of antihypertensive drugs to treat mental disorders is thus being explored. A systematic knowledge of the mechanisms of action and clinical consequences of the use of antihypertensive agents on neuropsychiatric functions has not been achieved yet. In this article, we review the putative role of antihypertensive agents in psychiatric disorders, discuss the targets and mechanisms of action, and examine how and to what extent specific drug classes/molecules may trigger, worsen, or mitigate psychiatric symptoms. In addition, we review pharmacokinetics (brain penetration of drugs) and pharmacogenetics data that add important information to assess risks and benefits of antihypertensive drugs in neuropsychiatric settings. The scientific literature shows robust evidence of a positive effect of α1 blockers on PTSD symptoms, nightmares and sleep quality, α2 agonists on core symptoms, executive function and quality of life in Attention-Deficit/Hyperactivity Disorder, PTSD, Tourette’s syndrome, and β blockers on anxiety, aggression, working memory, and social communication. Renin-angiotensin system modulators exert protective effects on cognition, depression, and anxiety, and the loop diuretic bumetanide reduced the core symptoms of autism in a subset of patients. There is no evidence of clear benefits of calcium channel blockers in mood disorders in the scientific literature. These findings are mainly from preclinical studies; clinical data are still insufficient or of anecdotal nature, and seldom systematic. The information herewith provided can support a better therapeutic approach to hypertension, tailored to patients with, or with high susceptibility to, psychiatric illness. It may prompt clinical studies exploring the potential benefit of antihypertensive drugs in selected patients with neuropsychiatric comorbidities that include outcomes of neuropsychiatric interest and specifically assess undesirable effects or interactions.

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Section: Renin-angiotensin System Modulatorsmentioning

confidence: 89%

Antihypertensive drugs and brain function: mechanisms underlying therapeutically beneficial and harmful neuropsychiatric effects

Carnovale

Perrotta

Baldelli

et al. 2022

Cardiovascular Research

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show abstract

“…The preferred use of ACEI, instead of ARB, should be explored whenever possible, especially in individuals with severe mental disorders (Mamdani et al, 2019). Nonetheless, when a subsequent analysis was performed in 2020, a nationwide population-based propensity score matching study demonstrate that ARB use was not associated with an increased risk for suicide compared with non-ARB use (Lin et al, 2020). In summary, epidemiological studies' evidence suggested relationships between the use of RAS medications and suicide were inconsistent.…”

Section: Opposite Results With Previous Workmentioning

confidence: 99%

Renin-angiotensin System: A New Promising Therapeutic and Mechanisms for Depression and Anxiety

Gong

deng

2022

Preprint

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Depression was an affective disorder, and the incidence of depression was increasing, which was projected to be the first disease burden worldwide by 2030. Therefore, it is particularly urgent to find new anti-depressant curative. The renin-angiotensin system (RAS) was important for regulating blood pressure, water, and electrolyte balance. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) were commonly used as first-line antihypertensive agents. A large number of basic studies confirmed that RAS played a key role in hypertension, affective disorders, and neurological diseases. Recently, studies have found that RAS blockers (ACEI/ARB) acted on the classical ACE/AngII/AT1 receptor pathway and ACE2/Ang-(1-7)/Mas receptor pathway, which may have promising clinical value for the treatment of anxiety disorders and depression. Therefore, the modulation role of RAS in the nervous system has progressively come to light. This review addresses the overview of the RAS, the relationship between RAS and depression/anxiety, and the potential mechanisms of RAS blockers in the therapy of affective disorders, involving brain inflammation, HPA axis, oxidative stress, and BDNF. The evidence for positive effects of RAS blockers on depression and anxiety alone or comorbidity was reviewed, hoping to provide a reference for new clinical uses, which go beyond blood pressure management.

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“…The preferred use of ACEI instead of ARB should be explored whenever possible, especially in individuals with severe mental disorders ( 219 ). Nonetheless, when a subsequent analysis was performed in 2020, a nationwide population-based propensity score matching study demonstrated that ARB use was not associated with an increased risk of suicide compared to non-ARB use ( 220 ). In summary, evidence from epidemiological studies suggests that the relationship between RAS medication use and suicide is inconsistent.…”

Section: Clinical Datamentioning

confidence: 99%

Renin-angiotensin system: The underlying mechanisms and promising therapeutical target for depression and anxiety

Gong

Deng

2023

Front. Immunol.

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Emotional disorders, including depression and anxiety, contribute considerably to morbidity across the world. Depression is a serious condition and is projected to be the top contributor to the global burden of disease by 2030. The role of the renin-angiotensin system (RAS) in hypertension and emotional disorders is well established. Evidence points to an association between elevated RAS activity and depression and anxiety, partly through the induction of neuroinflammation, stress, and oxidative stress. Therefore, blocking the RAS provides a theoretical basis for future treatment of anxiety and depression. The evidence for the positive effects of RAS blockers on depression and anxiety is reviewed, aiming to provide a promising target for novel anxiolytic and antidepressant medications and/or for improving the efficacy of currently available medications used for the treatment of anxiety and depression, which independent of blood pressure management.

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Association between angiotensin receptor blockers and suicide: nationwide population-based propensity score matching study

Cited by 5 publications

References 27 publications

Antihypertensive drugs and brain function: mechanisms underlying therapeutically beneficial and harmful neuropsychiatric effects

Antihypertensive drugs and brain function: mechanisms underlying therapeutically beneficial and harmful neuropsychiatric effects

Renin-angiotensin System: A New Promising Therapeutic and Mechanisms for Depression and Anxiety

Renin-angiotensin system: The underlying mechanisms and promising therapeutical target for depression and anxiety

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