Association of Antidepressant Use With Adverse Health Outcomes

Dragioti, Elena; Solmi, Marco; Favaro, Angela; Fusar‐Poli, Paolo; Dazzan, Paola; Thompson, Trevor; Stubbs, Brendon; Firth, Joseph; Fornaro, Michele; Tsartsalis, Dimitrios; Carvalho, André F.; Vieta, Eduard; McGuire, Philip; Young, Allan H.; Smıth, Lee; Correll, Christoph U.; Εvangelou, Εvangelos

doi:10.1001/jamapsychiatry.2019.2859

Cited by 160 publications

(165 citation statements)

References 101 publications

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“…In general, recent systematic reviews indicate that, once confounders are taken into account, selective serotonin reuptake inhibitors (SSRIs) are not associated with a clinically important increase in the risk of congenital malformations 122 or growth impairment 123 . SSRIs and other antidepressants may be associated with a small risk of prematurity, especially when used in the 2nd and 3rd trimesters 123‐125 , though this could reflect residual confounding by indication.…”

Section: Interventionsmentioning

confidence: 99%

“…There is considerably less evidence on longer‐term neurodevelopmental outcomes, but an emerging consensus that findings from preclinical (animal) studies may not apply to the human population 127 . For example, an initially concerning safety signal of an association between in utero exposure to SSRIs and autism spectrum disorder 128 is not supported by more recent, better quality evidence that takes into account confounding by underlying illness and familial variables 125,129 .…”

Section: Interventionsmentioning

confidence: 99%

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Perinatal mental health: a review of progress and challenges

2020

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Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high‐income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.

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Section: Interventionsmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

Perinatal mental health: a review of progress and challenges

2020

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“…The poor quality of data on safety of psychotropic medications can potentially induce a delay or refusal of treatment, despite evidence that medications used in psychiatry are generally not less effective than those prescribed in other fields of medicine 35 . For instance, poor reporting of adverse events in available randomized controlled trials (RCTs) may have led to inaccurate estimates of some serious events, such as suicidality with antidepressants 36 .…”

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confidence: 99%

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

et al. 2020

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Mental disorders frequently begin in childhood or adolescence. Psychotropic medications have various indications for the treatment of mental disorders in this age group and are used not infrequently off‐label. However, the adverse effects of these medications require special attention during developmentally sensitive periods of life. For this meta‐review, we systematically searched network meta‐analyses and meta‐analyses of randomized controlled trials (RCTs), individual RCTs, and cohort studies reporting on 78 a priori selected adverse events across 19 categories of 80 psychotropic medications – including antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity disorder (ADHD) medications and mood stabilizers – in children and adolescents with mental disorders. We included data from nine network meta‐analyses, 39 meta‐analyses, 90 individual RCTs, and eight cohort studies, including 337,686 children and adolescents. Data on ≥20% of the 78 adverse events were available for six antidepressants (sertraline, escitalopram, paroxetine, fluoxetine, venlafaxine and vilazodone), eight antipsychotics (risperidone, quetiapine, aripiprazole, lurasidone, paliperidone, ziprasidone, olanzapine and asenapine), three anti‐ADHD medications (methylphenidate, atomoxetine and guanfacine), and two mood stabilizers (valproate and lithium). Among these medications with data on ≥20% of the 78 adverse events, a safer profile emerged for escitalopram and fluoxetine among antidepressants, lurasidone for antipsychotics, methylphenidate among anti‐ADHD medications, and lithium among mood stabilizers. The available literature raised most concerns about the safety of venlafaxine, olanzapine, atomoxetine, guanfacine and valproate. Nausea/vomiting and discontinuation due to adverse event were most frequently associated with antidepressants; sedation, extrapyramidal side effects, and weight gain with antipsychotics; anorexia and insomnia with anti‐ADHD medications; sedation and weight gain with mood stabilizers. The results of this comprehensive and updated quantitative systematic meta‐review of top‐tier evidence regarding the safety of antidepressants, antipsychotics, anti‐ADHD medications and mood stabilizers in children and adolescents can inform clinical practice, research and treatment guidelines.

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“…This may reflect particular difficulties with a choice of AD to treat depression requiring a high number of switches in people with excess weight at a young age. This observation deserves further evaluation since certain types of AD were shown to be associated with the increased risk of suicides in this particular age group (68)(69)(70); therefore, choosing the most effective AD without a high number of switches may help decrease this risk. For middle aged patients, the relationship between AD number and BMI is less prominent.…”

Section: Discussionmentioning

confidence: 90%

Evaluating Prevalence and Patterns of Prescribing Medications for Depression for Patients With Obesity Using Large Primary Care Data (Canadian Primary Care Sentinel Surveillance Network)

et al. 2020

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Introduction: Depression is a serious disorder that brings a tremendous health and economic burden. Many antidepressants (AD) have obesogenic effects, increasing the population of obese patients at increased risk for a more severe disease course and poor treatment response. In addition, obese patients with depression may not be receiving the recommended standard of care due to "obesity bias." It is important to evaluate prescribing pharmacological treatment of depression in patients with obesity. Objectives: To describe the prevalence and patterns of AD prescribing for patients with depression and comorbid obesity compared with normal weight patients, and to examine the association of prescribing prevalence with obesity class. Methods: Study sample of adult patients (>18 years old) with depression was extracted from the national Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Electronic Medical Records database for 2011-2016. Measures were prescribing of at least one AD (outcome) and body mass index (BMI) to categorize patients into weight categories (exposure). Data were analyzed cross-sectionally using descriptive statistics and mixed effects logistic regression model with clustering on CPCSSN networks and adjusting for age, sex, and the comorbidities. Results: Of 120,381 patients with depression, 63,830 patients had complete data on studied variables (complete cases analysis). Compared with normal weight patients, obese patients were more likely to receive an AD prescription (adjusted Odds Ratio [aOR] = 1.17; 95% Confidence Interval [CI]: 1.12-1.22). Patients with obesity classes II and III were 8% (95% CI: 1.00, 1.16) and 6% (95% CI: 0.98, 1.16) more likely, respectively, to receive AD. After imputing missing data using Multiple Imputations by Chained Equations, the results remained unchanged. The prevalence of prescribing >3 AD types was higher Puzhko et al. Antidepressants Prescribing in Patients With Obesity in obese category (7.27%, [95% CI: 6.84, 7.73]) than in normal weight category (5.6%; [95% CI: 5.24, 5.99]). Conclusion: The association between obesity and high prevalence of AD prescribing and prescribing high number of different AD to obese patients, consistent across geographical regions, raises a public health concern. Study results warrant qualitative studies to explore reasons behind the difference in prescribing, and quantitative longitudinal studies evaluating the association of AD prescribing patterns for obese patients with health outcomes.

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Association of Antidepressant Use With Adverse Health Outcomes

Cited by 160 publications

References 101 publications

Perinatal mental health: a review of progress and challenges

Perinatal mental health: a review of progress and challenges

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

Evaluating Prevalence and Patterns of Prescribing Medications for Depression for Patients With Obesity Using Large Primary Care Data (Canadian Primary Care Sentinel Surveillance Network)

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