{"id":1683,"date":"2018-04-20T07:15:57","date_gmt":"2018-04-20T07:15:57","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=1683"},"modified":"2018-04-27T10:05:19","modified_gmt":"2018-04-27T10:05:19","slug":"adverse-effects-of-antidepressants-in-younger-adults","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/04\/20\/adverse-effects-of-antidepressants-in-younger-adults\/","title":{"rendered":"Adverse effects of antidepressants in younger adults"},"content":{"rendered":"<p>&nbsp;<\/p>\n<p><em>SSRIs might have higher rates of fracture than tricyclic antidepressants but lower mortality and adverse reactions.<\/em><\/p>\n<p style=\"text-align: right\">Carl Heneghan<\/p>\n<hr \/>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-thumbnail wp-image-1324 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2017\/06\/Carl-Heneghan-150x150.png\" alt=\"\" width=\"150\" height=\"150\" \/>Antidepressants are commonly prescribed. Yet, in those under 65, there is scant evidence on the risks associated with their use. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5842559\/\">A recent publication in BMC<\/a>\u00a0 looked at these risks in a cohort of 20 to 64-year olds.<\/p>\n<p><strong>What did they find?<\/strong><\/p>\n<p>The researchers retrospectively analysed 238,963 patients with a first diagnosis of depression registered with UK general practices. After 5 years of follow-up, they found the rate of fracture was 30% higher for selective serotonin reuptake inhibitors and 28% higher for other antidepressants (Mirtazapine and Venlafaxine) compared with the time periods when antidepressants were not used. At one year, the excess risk of fracture associated with SSRIs was 20 per 10,000 compared to those treated with tricyclic antidepressants, and 27 per 10,000 higher for the other antidepressants compared to tricyclics.<\/p>\n<p>Adverse drug reactions were 54% higher for tricyclic and related antidepressants and 61% higher for the other antidepressants compared with SSRIs. Trazodone was found to be associated with an increased risk of upper gastrointestinal bleeding.<\/p>\n<p>All-cause mortality rates were higher for tricyclic and related antidepressants and for the other antidepressants compared to SSRIs. Mirtazapine was associated with as more than doubling of mortality rates when compared with periods of non-use and was associated with an excess of 23 deaths per 10,000 compared with those treated with citalopram.<\/p>\n<p><strong>How secure is this information?<\/strong><\/p>\n<p>Now it goes without saying that cohort studies cannot infer causation. Those that are the most unwell, often receive the treatments which then seemingly cause the most harm. To account for this the researchers analysed a large number of potential confounding variables, however, this does not account for residual confounding. In addition, the number of falls and deaths was small, further hindering the interpretation. Finally, <a href=\"https:\/\/catalogofbias.org\/biases\/misclassification-bias\/\">misclassification bias<\/a> (we have written about this in the <a href=\"https:\/\/catalogofbias.org\/\">catalogue of bias<\/a>) occurs when a study participant is categorised into an incorrect category. In this case, individual may not have actually taken their medications despite being prescribed them, thus altering the observed association.<\/p>\n<p><strong>What can we conclude?<\/strong><\/p>\n<p>It is worth noting the shortcomings of observational data but this is still helpful information that should be considered in terms of when, and when not, to prescribe antidepressants. The issue with some of these drugs and their harms are\u00a0 worth further investigation.<\/p>\n<p>Reference<br \/>\nCoupland C., Hill T., Morriss R., Moore M., Arthur A., &amp; Hippisley-Cox J. (2018). Antidepressant use and risk of adverse outcomes in people aged 20-64 years: Cohort study using a primary care database. BMC Medicine, 16(1), 36.<\/p>\n<hr \/>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1618 alignright\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2-1.png\" alt=\"\" width=\"380\" height=\"203\" srcset=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2-1.png 380w, https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2-1-300x160.png 300w\" sizes=\"auto, (max-width: 380px) 100vw, 380px\" \/><\/p>\n<p>BMJ\u00a0<a href=\"http:\/\/ebm.bmj.com\/\">Evidence-Based Medicine<\/a>\u00a0\u2013\u00a0original evidence-based research, insights and opinions on what matters for health care.<\/p>\n<hr \/>\n<p>Carl Heneghan is<a href=\"http:\/\/www.phc.ox.ac.uk\/team\/researchers\/carl-heneghan\">\u00a0Professor of EBM<\/a>\u00a0at the University of Oxford,<a href=\"http:\/\/www.cebm.net\/\">\u00a0Director of CEBM<\/a>\u00a0and Editor in Chief of BMJ <a href=\"http:\/\/ebm.bmj.com\/\">Evidence-Based Medicine<\/a><\/p>\n<p><em>Follow on twitter\u00a0<a href=\"https:\/\/twitter.com\/carlheneghan?lang=en\">@carlheneghan<\/a><\/em><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p><b>Competing interests<\/b><\/p>\n<p>Carl has received expenses and fees for his media work including BBC Inside Health. He holds grant funding from the NIHR, the NIHR School of Primary Care Research, The NIHR Oxford BRC\u00a0 and the WHO. He has also received income from the publication of a series of toolkit books. CEBM jointly runs the\u00a0<a title=\"\" href=\"http:\/\/evidencelive.org\/\">EvidenceLive<\/a>\u00a0Conference with the BMJ and the\u00a0<a title=\"\" href=\"http:\/\/www.preventingoverdiagnosis.net\/\">Overdiagnosis Conference<\/a>\u00a0with some international partners which are based on a\u00a0 non-profit model.<strong>\u00a0<\/strong><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; SSRIs might have higher rates of fracture than tricyclic antidepressants but lower mortality and adverse reactions. Carl Heneghan Antidepressants are commonly prescribed. Yet, in those under 65, there is scant evidence on the risks associated with their use. A recent publication in BMC\u00a0 looked at these risks in a cohort of 20 to 64-year [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/04\/20\/adverse-effects-of-antidepressants-in-younger-adults\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":1456,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14374,14388,14370],"tags":[],"class_list":["post-1683","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-carl-heneghan","category-evidence-watch","category-uncategorised"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Adverse effects of antidepressants in younger adults - BMJ EBM Spotlight<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/04\/20\/adverse-effects-of-antidepressants-in-younger-adults\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Adverse effects of antidepressants in younger adults - BMJ EBM Spotlight\" \/>\n<meta property=\"og:description\" content=\"&nbsp; SSRIs might have higher rates of fracture than tricyclic antidepressants but lower mortality and adverse reactions. Carl Heneghan Antidepressants are commonly prescribed. Yet, in those under 65, there is scant evidence on the risks associated with their use. A recent publication in BMC\u00a0 looked at these risks in a cohort of 20 to 64-year [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/04\/20\/adverse-effects-of-antidepressants-in-younger-adults\/\" \/>\n<meta property=\"og:site_name\" content=\"BMJ EBM Spotlight\" \/>\n<meta property=\"article:published_time\" content=\"2018-04-20T07:15:57+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2018-04-27T10:05:19+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2017\/10\/download4.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"380\" \/>\n\t<meta property=\"og:image:height\" content=\"250\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/04\\\/20\\\/adverse-effects-of-antidepressants-in-younger-adults\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/04\\\/20\\\/adverse-effects-of-antidepressants-in-younger-adults\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Adverse effects of antidepressants in younger adults\",\"datePublished\":\"2018-04-20T07:15:57+00:00\",\"dateModified\":\"2018-04-27T10:05:19+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/04\\\/20\\\/adverse-effects-of-antidepressants-in-younger-adults\\\/\"},\"wordCount\":541,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/04\\\/20\\\/adverse-effects-of-antidepressants-in-younger-adults\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/files\\\/2017\\\/10\\\/download4.jpeg\",\"articleSection\":[\"Carl Heneghan\",\"Evidence Watch\"],\"inLanguage\":\"en-GB\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/04\\\/20\\\/adverse-effects-of-antidepressants-in-younger-adults\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/04\\\/20\\\/adverse-effects-of-antidepressants-in-younger-adults\\\/\",\"name\":\"Adverse effects of antidepressants in younger adults - 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