Bidirectional associations between mental disorders, antidepressants and cardiovascular disease

Abstract

BackgroundMental disorders have a high comorbidity with cardiovascular disease (CVD), but the causality between them has not been fully appreciated.ObjectiveThis study aimed to systematically explore the bidirectional causality between the two broad categories of diseases.MethodsWe conducted Mendelian randomisation (MR) and multivariable MR (MVMR) analyses to evaluate potential causal links between 10 mental disorders, the use of antidepressants and 7 CVDs.FindingsWe discovered that major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD) and insomnia exhibit connections with elevated risks of two or more CVDs. Moreover, the use of antidepressants is linked to heightened risks of each CVD. Each distinct CVD is correlated with a greater probability of taking antidepressants. Our MVMR analysis demonstrated that the use of antidepressants is correlated with the elevation of respective risks across all cardiovascular conditions. This includes arrhythmias (OR: 1.28), atrial fibrillation (OR: 1.44), coronary artery disease (OR: 1.16), hypertension (OR: 1.16), heart failure (OR: 1.16), stroke (OR: 1.44) and entire CVD group (OR: 1.35). However, MDD itself was not linked to a heightened risk of any CVD.ConclusionsThe findings of our study indicate that MDD, insomnia and ADHD may increase the risk of CVD. Our findings highlight the utilisation of antidepressants as an independent risk factor for CVD, thus explaining the influence of MDD on CVD through the mediating effects of antidepressants.Clinical implicationsWhen treating patients with antidepressants, it is necessary to take into consideration the potential beneficial and detrimental effects of antidepressants.

The causal relationship between sleep and risk of psychiatric disorders: A two-sample mendelian randomization study

“…This link is crucial for understanding the broader implications of sleep disorders on mental health and underscores the importance of addressing sleep disturbances within mental health treatment paradigms ( Baranova et al, 2022 ). In addition to psychiatric disorders, insomnia has demonstrated associations with systemic diseases such as cardiovascular disease, as discussed in recent studies ( Cao et al, 2024 ). This connection suggests that the scope of insomnia’s impact extends well beyond mental health, influencing overall physical health and potentially complicating treatment approaches for related physical ailments.…”

Table1.DOCX

“…This link is crucial for understanding the broader implications of sleep disorders on mental health and underscores the importance of addressing sleep disturbances within mental health treatment paradigms (Baranova et al, 2022). In addition to psychiatric disorders, insomnia has demonstrated associations with systemic diseases such as cardiovascular disease, as discussed in recent studies (Cao et al, 2024). This connection suggests that the scope of insomnia's impact extends well beyond mental health, influencing overall physical health and potentially complicating treatment approaches for related physical ailments.…”