Distinct effects of antihypertensives on depression in the real-world setting: A retrospective cohort study

Cao, Yanjun; Xiang, Xiao Juan; Song, Jinlin; Tian, Yaohua; Wang, M.Y.; Wang, X.W.; Li, Miao; Huang, Zi-Ting; Wu, Yao; Wu, Tao; Hu, Yuelin

doi:10.1016/j.jad.2019.08.075

Cited by 20 publications

(22 citation statements)

References 39 publications

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“…Supporting this conclusion, we then compared ARBs directly with ACEIs, and showed a lower risk of all outcomes with ARBs, except for sleep disorders and marginally for anxiety disorders (Table 5). These findings extend a range of previous findings indicating a beneficial effect of ARBs on the risk of psychiatric disorders [1][2][3]5,7,22 , neurodegenerative diseases 23 , and quality of life 24 . Various mechanisms have been postulated, mostly focusing on central angiotensin receptors and their interaction with the dopamine system 25 , and their anti-inflammatory properties 7 .…”

Section: Discussionsupporting

confidence: 88%

“…Prior observational studies have suggested that AHT classes may be associated with a differential incidence of onset or relapse of depression [1][2][3]5,7,8 and some other psychiatric disorders 2,4,6 . Our data extend this evidence and clarify its interpretation, by virtue of the much larger sample sizes, the richness of available data, closer control over confounding factors, and the use of negative control outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…These authors also found that a diagnosis of bipolar disorder was less common with ARBs and ACEIs. In a retrospective cohort study of hypertensive patients using a Chinese insurance database, lower rates of depression occurred in patients treated with ARBs than with other AHTs; ACEIs and β-blockers were associated with the highest rates 3 . In the Swedish population, patients with serious mental illness, mostly schizophrenia, and bipolar disorder had lower rates of psychiatric hospitalization and self-harm when they were taking CCBs compared to when they were not; other AHTs were not analyzed 4 .…”

Section: Introductionmentioning

confidence: 99%

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Onset and recurrence of psychiatric disorders associated with anti-hypertensive drug classes

2021

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The major anti-hypertensive (AHT) drug classes have been associated with differential risks of psychiatric disorders. However, existing data are limited largely to depression, and confounding variables have not always been controlled for. We sought to fill the evidence gap, using TriNetX Analytics, an electronic health records network. Amongst 58.6 million patients aged 18–90 years, patients prescribed a calcium channel blocker (CCB) were compared with those taking a diuretic, angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or β-blocker. Cohorts were propensity score-matched for age, sex, race, and blood pressure. Over a 2-year exposure period, we measured the incidence and risk ratio of a first diagnosis (ICD-10 codes), or a recurrence, of psychotic, affective, and anxiety disorders, as well as substance use disorders and sleep disorders. Cohort sizes ranged from 33,734 to 322,814. CCBs were associated with a lower incidence of psychotic, affective, and anxiety disorders than β-blockers (risk ratios 0.69–0.99) and a higher incidence than ARBs (risk ratios 1.04–2.23) for both first and recurrent diagnoses. Comparisons of CCBs with ACEIs or diuretics showed smaller risk ratios that varied between disorders, and between first episode and recurrence. AHT classes were also associated with the incidence of substance use and sleep disorders. Results remained largely unchanged after more extensive cohort matching for additional potential confounders. In a secondary analysis, a comparison between ARBs and ACEIs showed lower rates of psychotic, affective, and substance use disorders with ARBs, but higher risks of anxiety and sleep disorders. In conclusion, AHT classes are differentially associated with the incidence of psychiatric disorders. ARBs show the most advantageous profile and β-blockers the least. The apparent beneficial effects of ARBs merit further study.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Onset and recurrence of psychiatric disorders associated with anti-hypertensive drug classes

2021

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“…However, experimental data suggest that RAS inhibitors may have mood-elevating effects (111). Also, some (112)(113)(114), but not all (115,116), explorative observational studies have suggested that RAS inhibitors may protect against depression.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Microvascular Contribution to Late-Onset Depression: Mechanisms, Current Evidence, Association With Other Brain Diseases, and Therapeutic Perspectives

Empana

Boutouyrie

Lemogne

et al. 2021

Biological Psychiatry

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Similarly, a meta-analysis (Vian et al, 2017) covering an extensive period (1974-2017) suggests a potential antidepressant effect of both drug groups. In contrast, a large retrospective cohort study (Cao et al, 2019) showed different effects for ACE-Is and ARBs. Namely, the frequency of depression was significantly higher in patients taking ACE-Is than in those treated with ARBs.…”

Section: Drugs That Affect the Raa Systemmentioning

confidence: 87%

Influence of selected drugs used in the treatment of type 2 diabetes and cardiovascular diseases on depressive disorders in elderly patients

Słomińska

Manikowska

Hoszman

et al. 2021

Pharmacotherapy in Psychiatry and Neurology

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Objectives. In geriatric patients, cardiovascular diseases and type 2 diabetes are considered the most common chronic health problems. Moreover, increasing the prevalence of depression, which significantly reduces the quality of life and increases disability in this group, has also been observed. This paper aims to review the literature on the relationship between drugs from selected pharmacological groups used in the treatment of diabetes and cardiovascular diseases and depression, both with respect to their depressive and antidepressant effects. Literature review. The increased risk of the prevalence and the severity of depression is associated with strongly lipophilic beta-blockers and insulin therapy. In contrast, drugs that block the RAA system reduce the risk of developing and worsening symptoms of depression and improve cognitive function in elderly patients. Literature reports indicate the antidepressant effect of commonly used antidiabetic drugs such as metformin and incretin drugs (GLP-1 analogues and DPP-4 inhibitors). The potential anti-depressive effect of intranasal insulin administration requires further research. Conclusions. Based on the review, it should be stated that due to the frequent occurrence of mood disorders in elderly patients, the selection of drugs used in the therapy of somatic diseases should allow for the risk of causing or worsening symptoms of depression. However, the possibility of their beneficial effect on mood disorders should also be considered.

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Distinct effects of antihypertensives on depression in the real-world setting: A retrospective cohort study

Cited by 20 publications

References 39 publications

Onset and recurrence of psychiatric disorders associated with anti-hypertensive drug classes

Onset and recurrence of psychiatric disorders associated with anti-hypertensive drug classes

Microvascular Contribution to Late-Onset Depression: Mechanisms, Current Evidence, Association With Other Brain Diseases, and Therapeutic Perspectives

Influence of selected drugs used in the treatment of type 2 diabetes and cardiovascular diseases on depressive disorders in elderly patients

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