Venous Thromboembolism Risk With Antidepressants: Driven by Disease or Drugs?

The causal relationship between antidepressant use and venous thromboembolism

“…Based on the results of the Million Women Study in the UK [19], which showed no signi cant increase in the risk of VTE in women treated for depression but not taking antidepressants, it has been hypothesized that antidepressants, rather than depression, are driving VTE to develop [40]. In a previous study, Parkin et al hypothesized that tricyclic antidepressants and phenothiazines share chemical similarities, which could account for the observed risk relationship between antidepressant use and PE [23].…”

“…Antipsychotics called phenothiazines have been shown to raise the risk of VTE by promoting platelet aggregation [41], as well as aggravation of venous blood stasis due to sedative effects [42]. Interestingly, in the Million Women Study, users of tricyclic antidepressants (adjusted HR: 1.32), selective 5-hydroxytryptamine reuptake inhibitors (adjusted HR: 1.40), and other antidepressants (adjusted HR: 1.61) had a similarly increased risk of VTE [19], and it has therefore also been suggested that the increased risk of VTE may be related to the depression itself rather than due to the antidepressant [40]. It is well known that the results of observational studies are often affected by various types of factors, such as small sample size, residual confounding, reverse causality, etc [43].…”

Obesity, thrombosis, venous disease, lymphatic disease, and lipedema: An obesity medicine association (OMA) clinical practice statement (CPS) 2023

“… Risk factors for thrombosis beyond obesity o Personal or family history of thrombotic disease o Inherited coagulation or platelet disorders o Older age o Female sex o Pregnancy o Antiphospholipid antibody syndrome o Smoking o Immobilization o Malignancy o Pathogenic medical conditions involving the following body systems: cardiovascular, renal, hematologic, rheumatologic, gastrointestinal, infectious, respiratory, and endocrine (e.g., polycystic ovary syndrome and diabetes mellitus) o Trauma or surgery (especially major orthopedic and neurovascular surgery) o Medications (e.g., estrogens, systemic glucocorticoids, tamoxifen, testosterone, and some antidepressants [ 164 ]) o Inflammatory disorders Diagnosis of venous thrombosis o D-dimer testing o Venous ultrasonography o CT pulmonary angiography and ventilation-perfusion scan for possible pulmonary emboli o Venography (i.e., contrast dye and imaging via X-ray, computed tomography, or magnetic resonance imaging) Challenges with imaging techniques among patients with obesity suspected of deep venous thrombosis and/pulmonary embolism [ 132 ]. o Imaging table sizes and gantry diameter may not accommodate patients with severe obesity o Obesity may compromise image quality o Patients with obesity may present difficulties in locating anatomical landmarks, which can impair proper technique and positioning o Patients with obesity may require higher radiation doses and prolonged CT imaging time, increasing radiation exposure o CT pulmonary angiography is the most common imaging study to assess for potential pulmonary embolism.…”

<p>Prevalence of Asymptomatic Venous Thromboembolism in Depressive Inpatients</p>

“…Since the 2000s, a series of large-scale observational studies were performed to investigate the relationships between depression, antidepressant use, and VTE. [5][6][7][8][9] In 2018, Kunutsor et al meta-analyzed previous studies and reported that individuals with depression had a 1.31-fold and those using antidepressants a 1.27-fold increased risk of VTE. 10 Parkin et al reported in a large prospective cohort study of women that the group taking antidepressants had a 1.22-fold increased risk of VTE compared to the group who showed depression or anxiety symptoms but did not take psychotropic drugs.…”