Tricyclic Antidepressant Use and Risk of Fractures: A Meta-Analysis of Cohort Studies through the Use of Both Frequentist and Bayesian Approaches

Abstract

Background: Research findings regarding the association between tricyclic antidepressant (TCA) treatment and the risk of fracture are not consistent; we aimed to assess whether people who take TCAs are at an increased fracture risk. Methods: Relevant studies published through June 2020 were identified through database searches of MEDLINE, EMBASE, Scopus, PsycINFO, ISI Web of Science, WorldCat Dissertations and Theses from each database’s inception, as well as through manual searches of relevant reference lists. Two researchers independently performed literature searches, study selection, data abstraction and study appraisal by using a standardized protocol. Frequentist and Bayesian hierarchical random-effects models were used for the analysis. The heterogeneity and publication bias were evaluated in this study. Results: Eight studies met the inclusion criteria. Overall, TCA use was associated with a significantly increased risk of fracture in both the frequentist approach (Risk Ratio (RR), 1.23; 95% CI, 1.06−1.42; p = 0.007) and the Bayesian method (RR, 1.24, 95% Credible Interval (CrI), 1.01−1.56). These results were consistent in multiple sensitivity and subgroup analyses. Significant heterogeneity was observed in the meta-analysis; however, no significant publication bias was detected. Conclusion: TCA medication may indicate an increased risk of fracture. TCA should be prescribed with caution in the clinic.

Doxepin Exacerbates Renal Damage, Glucose Intolerance, Nonalcoholic Fatty Liver Disease, and Urinary Chromium Loss in Obese Mice

“…To evaluate post–doxepin treatment IR and insulin function in our mice, we used HOMA-IR and IS indexes; these indices are based on fasting blood glucose according to the HOMA method, which has been validated against clamp measurements [ 8 , 9 , 10 , 11 ]: HOMA-IR = [fasting insulin (mU/L) × fasting glucose (mmol/L)]/22.5 IS index = [1/fasting insulin (mU/L) × fasting glucose (mmol/L)] × 1000 …”

“…To evaluate post-doxepin treatment IR and insulin function in our mice, we used HOMA-IR and IS indexes; these indices are based on fasting blood glucose according to the HOMA method, which has been validated against clamp measurements [8][9][10][11]…”

“…Patients under tricyclic sedating antidepressant treatment, however, may exhibit memory impairment, dry mouth, drowsiness, fine tremor, micturition difficulty, constipation, postural hypotension, dyslipidemia, and weight gain [7][8][9]. Many commonly used psychotropic medications, particularly antipsychotics, and antidepressants, have recently been independently associated with endocrine and metabolic factors such as insulin resistance (IR), obesity, and dyslipidemia [8,10].…”

“…The side effects-including tiredness, headache, palpitation, perspiration, constipation, as well as sleep-and micturition-related problems [20,21]-of tricyclic antidepressants may reduce patient compliance and thus increase health care costs and exacerbate the physical and financial burdens on patients themselves and their caregivers [8,9]. However, in comparison with different antipsychotics (e.g., clozapine, risperidone, olanzapine, and haloperidol), doxepin treatment is less likely to alter the patient's physical parameters (e.g., body weight and lipid profile) in the long term [22][23][24].…”

The Relationship between Complications, Common Knowledge Details and Self-handicapping Strategies and Veracity: A Meta-analysis

“…Indeed, whilst the frequentist approach makes use of conditional distributions of the data given the hypothesis, the Bayesian makes use of probability for the data as well as for the hypotheses. On the other hand, it is believed that it might be fruitful to employ both, and there are indeed examples where this has been done (Hong et al, 2013;Wu et al, 2020). Indeed, a comparison of the two frameworks can shed light on the consistency of the results when applying different methods.…”