Source: University of Bristol.
In the first review of its kind, new research has found that depression and the use of antidepressants are each associated with an increased risk of venous thromboembolism (VTE). The study led by academics from the Musculoskeletal Research Unit at the University of Bristol has also shown that each of the various classes of antidepressant medications are associated with an increased risk of VTE.
VTE, a condition in which blood clots form in the veins of the legs or lungs, is a life-threatening condition and its treatment is associated with high healthcare costs. The research, published in Annals of Medicine, conducted a systematic review and meta-analysis of published observational studies evaluating the associations of depression and antidepressant use with VTE risk.
There have been reports that both depression and use of antidepressant drugs might be associated with an increased risk of VTE. These reports have, however, been conflicting. Previous studies have reported mixed results, some reporting evidence of associations and others reporting no evidence of associations. The researchers have clarified the evidence by bringing all published studies together.
Though the study could not prove if the observed findings are mainly driven by the antidepressant drugs or depression itself or both, it does show that a relationship exists between depression, antidepressant use, and VTE.
Antidepressant medications have multiple indications, which include anxiety, pain, and neuralgia and their use is on the increase on a global scale. Given that VTE is a public health burden, the study’s findings highlight the need for prescribers and healthcare professionals to evaluate patients to determine their excess risk of VTE during their management.
Dr Setor Kunutsor, Research Fellow from the Musculoskeletal Research Unit at the Bristol Medical School: Translational Health Sciences (THS) and lead researcher, said: “These findings are very useful to me as both a clinician and a researcher. It gives me the information I need, especially when prescribing antidepressant medications to my patients.”
The research findings do not prove cause and effect and further studies are needed to show if the associations the study has demonstrated are causal and whether it is depression or antidepressant use or both which drives an increase in VTE risk. These would need to involve studies that are able to isolate depression from antidepressant medications. For example, researchers could assess if individuals who are not depressed but use antidepressants for a condition such as neurologic or gastrointestinal disease, are at an increased risk of VTE.
Source: Joanne Fryer – University of Bristol
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Original Research: Abstract for “Depression, antidepressant use, and risk of venous thromboembolism: systematic review and meta-analysis of published observational evidence” by Setor K. Kunutsor, Samuel Seidu & Kamlesh Khunti in Annals of Medicine. Published July 12 2018.
Depression, antidepressant use, and risk of venous thromboembolism: systematic review and meta-analysis of published observational evidence
Purpose: Evidence on the association between depression, antidepressant use and venous thromboembolism (VTE) risk is conflicting. We conducted a systematic review and meta-analysis of published observational studies evaluating the associations of depression and antidepressant use with VTE risk.
Design: Eligible studies were identified in a literature search of MEDLINE, Embase, Web of Science and reference list of relevant studies up to April 2018. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated aggregated using random effects models.
Results: Eight observational studies with data on 960 113 non-overlapping participants and 9027 VTE cases were included. The pooled RR (95% CI) for VTE comparing antidepressant use with no antidepressant use was 1.27 (1.06-1.51). Tricyclic antidepressants, selective serotonin reuptake inhibitors and other antidepressants were each associated with an increased VTE risk; 1.16 (1.06-1.27), 1.12 (1.02-1.23), and 1.59 (1.21-2.09) respectively. In pooled analysis of three studies that compared patients with depression versus individuals without depression, the RR for VTE was 1.31 (1.13-1.53).
Conclusion: Pooled observational evidence suggests that depression and use of antidepressants are each associated with an increased VTE risk. The effect of antidepressant drugs on VTE may be a class effect. The mechanistic pathways underlying these associations deserve further evaluation.