The use of antidepressants and the risk of chronic atrial fibrillation

Lapi, Franco; Azoulay, Laurent; Kezouh, Abbas; Benisty, Jacques; Matok, Ilan; Mugelli, Alessandro; Suissa, Samy

doi:10.1002/jcph.435

Cited by 14 publications

(11 citation statements)

References 54 publications

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“…Furthermore, this explanation goes against other studies, which conclude that antidepressant use per se is not associated with AF risk. 22,23…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, this explanation goes against other studies, which conclude that antidepressant use per se is not associated with AF risk. 22,23 A plausible interpretation could be that depression increases the risk of incident AF. An extensive body of research has reported that depression is associated with dysregulation in the autonomic nervous system, particularly excessive sympathetic activity, which can contribute to cardiovascular morbidity.…”

Section: Interpretation and Implications Of Findingsmentioning

confidence: 99%

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Depression, antidepressants, and the risk of non-valvular atrial fibrillation: A nationwide Danish matched cohort study

Fenger‐Grøn

Vestergaard

Pedersen

et al. 2018

Eur J Prev Cardiolog

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Background: Depression is associated with an increased risk of a series of cardiovascular diseases and with increased symptom burden in patients with atrial fibrillation. The aim of this study was to determine the association between depression as well as antidepressant treatment and the risk of incident atrial fibrillation. Design: A nationwide register-based study comparing the atrial fibrillation risk in all Danes initiating antidepressant treatment from 2000 to 2013 (N ¼ 785,254) with that in a 1:5-matched sample from the general population. Methods: Cox regression was used to estimate adjusted hazard ratios (aHRs) and associated 95% confidence intervals (95% CIs), both after initiation of treatment and in the month before when patients were assumed to have medically untreated depression. Results: Antidepressant treatment was associated with a threefold higher risk of atrial fibrillation during the first month (aHR ¼ 3.18 (95% CI: 2.98-3.39)). This association gradually attenuated over the following year (aHR ¼ 1.37 (95% CI: 1.31-1.44) 2-6 months after antidepressant therapy initiation, and aHR ¼ 1.11 (95% CI: 1.06-1.16) 6-12 months after). However, the associated atrial fibrillation risk was even higher in the month before starting antidepressant treatment (aHR ¼ 7.65 (95% CI: 7.05-8.30) from 30 to 15 days before, and aHR ¼ 4.29 (95% CI: 3.94-4.67) the last 15 days before). Overall, 0.4% of patients were diagnosed with atrial fibrillation from 30 days before to 30 days after antidepressant treatment. Conclusions: Antidepressant users had a substantially increased atrial fibrillation risk, particularly before treatment initiation. Whether this mirrors a causal relation between depression and atrial fibrillation may have large consequences for public health and should be discussed.

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“…Furthermore, this explanation goes against other studies, which conclude that antidepressant use per se is not associated with AF risk. 22,23…”

Section: Discussionmentioning

confidence: 99%

Section: Interpretation and Implications Of Findingsmentioning

confidence: 99%

Depression, antidepressants, and the risk of non-valvular atrial fibrillation: A nationwide Danish matched cohort study

Fenger‐Grøn

Vestergaard

Pedersen

et al. 2018

Eur J Prev Cardiolog

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“…More recently, PTSD has received attention and demonstrates a relatively small, yet significant, effect size in a large study in veterans. Nevertheless, the evidence remains conflicting, as a number of studies did not observe significant effects of psychosocial stress [12,13] and depression or antidepressant use [12,15] on the incidence of AF.…”

Section: Impact Of Adverse Psychological Factors On Af Incidencementioning

confidence: 99%

Psychological aspects of atrial fibrillation: A systematic narrative review

et al. 2020

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Purpose of the review Atrial fibrillation (AF) is the most frequent arrhythmia in the general population. This review aims to provide a comprehensive overview of the psychological aspects of AF, compiling evidence from epidemiological, clinical, and basic research sources. Recent findings Findings from large-scale population-based and clinical longitudinal studies reveal an association between negative affectivity (e.g. depression) and the incidence and clinical prognosis of AF. Studies investigating the impact of work stress parameters on AF onset show conflicting results. Researchers have reported the impact of AF on cognitive decline and on health-related quality of life, and have highlighted the role of interoceptive cues in the development of AF symptom burden and gender differences in psychological covariates of AF. Among biological pathways linking psychosocial factors to AF, research on autonomic regulation has yielded the most evidence so far, showing that the onset of AF is associated with simultaneous sympatho-vagal activation rather than an increase in vagal or sympathetic drive alone. Thus, modulation of the autonomic nervous system is likely to be a promising strategy for protecting the myocardium from pro-arrhythmic autonomic influences. Summary In total, the findings show that AF is embedded as a disease condition in a psycho-societal context and is not an isolated medical problem per se. A broader perspective than a focus on the electrophysiology alone is urgently needed.

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“…Four of them reported that the risk of incident AF in antidepressant users was substantially increased. Only the study from Lapi et al indicated that exposure to antidepressants is not associated with the increased risk of AF ( 38 ). As shown in Figure 3 , the outcome of our meta-analysis support that the risk of incident AF was significantly increased in the antidepressant using population (RR = 1.16, 95% CI, 1.07–1.25, P < 0.001).…”

Section: Resultsmentioning

confidence: 99%

Association of Depression, Antidepressants With Atrial Fibrillation Risk: A Systemic Review and Meta-Analysis

Feng

et al. 2022

Front. Cardiovasc. Med.

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BackgroundDepression is a possible influence factor for the increased risk of incident atrial fibrillation (AF). Although several investigations have assessed their association, the results are still controversial. Therefore, we conducted a meta-analysis to evaluate the association between depression or using antidepressants and AF.MethodsWe systemically performed the literature retrieval from two electronic databases PubMed and EMBASE until March 2022 to extract relevant data. The hazard ratios (HRs) and odds ratios (OR) from included studies with 95% confidence intervals (CIs) were adjusted into the risk ratio (RR) and pooled by using the random-effects model.ResultsTotally 9 studies about the associations between depression or antidepressants and incident AF risk were included in this meta-analysis. Among them, 5 studies specifically analyzed the impact of antidepressants on the risk of AF. The outcomes of our analysis indicated that depression or depressive symptoms could increase AF risk (RR = 1.15, 95% CI, 1.03–1.27, P < 0.01). In addition, the use of antidepressants can also increase AF risk (RR = 1.16, 95% CI, 1.07–1.25, P < 0.001). These results remained unchanged when we remove the source of heterogeneity or adjust the analysis model into the fixed-effects model.ConclusionsBased on existing investigations, both depression and the use of antidepressants are closely related to the increase of incident AF risk.

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The use of antidepressants and the risk of chronic atrial fibrillation

Cited by 14 publications

References 54 publications

Depression, antidepressants, and the risk of non-valvular atrial fibrillation: A nationwide Danish matched cohort study

Depression, antidepressants, and the risk of non-valvular atrial fibrillation: A nationwide Danish matched cohort study

Psychological aspects of atrial fibrillation: A systematic narrative review

Association of Depression, Antidepressants With Atrial Fibrillation Risk: A Systemic Review and Meta-Analysis

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