Skip to main content
Article
Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women's Health Initiative study
UMass Worcester Prevention Research Center Publications and Presentations
  • Jordan W. Smoller, Massachusetts General Hospital
  • Matthew Allison, University of California San Diego
  • Barbara B. Cochrane, University of Washington - Seattle Campus
  • J. David Curb, University of Hawaii
  • Roy H. Perlis, Massachusetts General Hospital
  • Jennifer G. Robinson, University of Iowa
  • Milagros C. Rosal, University of Massachusetts Medical School
  • Nanette K. Wenger, Emory School of Medicine
  • Sylvia Wassertheil-Smoller, Albert Einstein College of Medicine
UMMS Affiliation
Department of Medicine, Division of Preventive and Behavioral Medicine
Date
12-14-2009
Document Type
Article
Medical Subject Headings
Aged; Antidepressive Agents; Cardiovascular Diseases; Female; Humans; Incidence; Middle Aged; Postmenopause; Prospective Studies; Risk Factors; Women's Health
Abstract
BACKGROUND: Antidepressants are commonly prescribed medications, but their effect on cardiovascular morbidity and mortality remains unclear. METHODS: Prospective cohort study of 136 293 community-dwelling postmenopausal women in the Women's Health Initiative (WHI). Women taking no antidepressants at study entry and who had at least 1 follow-up visit were included. Cardiovascular morbidity and all-cause mortality for women with new antidepressant use at follow-up (n = 5496) were compared with those characteristics for women taking no antidepressants at follow-up (mean follow-up, 5.9 years). RESULTS: Antidepressant use was not associated with coronary heart disease (CHD). Selective serotonin reuptake inhibitor (SSRI) use was associated with increased stroke risk (hazard ratio [HR],1.45, [95% CI, 1.08-1.97]) and all-cause mortality (HR,1.32 [95% CI, 1.10-1.59]). Annualized rates per 1000 person-years of stroke with no antidepressant use and SSRI use were 2.99 and 4.16, respectively, and death rates were 7.79 and 12.77. Tricyclic antidepressant (TCA) use was associated with increased risk of all-cause mortality (HR,1.67 [95% CI, 1.33-2.09]; annualized rate, 14.14 deaths per 1000 person-years). There were no significant differences between SSRI and TCA use in risk of any outcomes. In analyses by stroke type, SSRI use was associated with incident hemorrhagic stroke (HR, 2.12 [95% CI, 1.10-4.07]) and fatal stroke (HR, 2.10 [95% CI, 1.15-3.81]). CONCLUSIONS: In postmenopausal women, there were no significant differences between SSRI and TCA use in risk of CHD, stroke, or mortality. Antidepressants were not associated with risk of CHD. Tricyclic antidepressants and SSRIs may be associated with increased risk of mortality, and SSRIs with increased risk of hemorrhagic and fatal stroke, although absolute event risks are low. These findings must be weighed against quality of life and established risks of cardiovascular disease and mortality associated with untreated depression.
Comments

Citation: Smoller JW, Allison M, Cochrane BB, Curb JD, Perlis RH, Robinson JG, Rosal MC, Wenger NK, Wassertheil-Smoller S. Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women's Health Initiative study. Arch Intern Med. 2009 Dec 14;169(22):2128-39. doi:10.1001/archinternmed.2009.436.

Related Resources
Link to Article in PubMed
PubMed ID
20008698
Citation Information
Jordan W. Smoller, Matthew Allison, Barbara B. Cochrane, J. David Curb, et al.. "Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women's Health Initiative study" Vol. 169 Iss. 22 (2009) ISSN: 0003-9926 (Linking)
Available at: http://works.bepress.com/milagros_rosal/80/