Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.
Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, United Kingdom.
PLoS One. 2021 Jan 29;16(1):e0245722. doi: 10.1371/journal.pone.0245722. eCollection 2021.
Obesity, depressive disorders and antidepressant drugs are associated with increased mortality, cardiovascular disease, diabetes, fractures and falls. We explored outcomes associated with the most commonly prescribed antidepressants in overweight or obese people with depression.
We identified a cohort of overweight or obese adults (≥18 years) in primary care from the UK Clinical Practice Research Datalink, linked with hospital and mortality data, between 1 January 2000 and 31 December 2016 who developed incident depression to January 2019. Cox proportional hazards models and 99% confidence intervals were used to estimate hazard ratios (HR) for mortality, cardiovascular disease, diabetes, and falls/fractures associated with exposure to selective serotonin reuptake inhibitors (SSRIs), tricyclic (TCA)/other, combination antidepressants, citalopram, fluoxetine, sertraline, amitriptyline and mirtazapine, adjusting for potential confounding variables. In 519,513 adults, 32,350 (9.2 per 1,000 years) displayed incident depression and 21,436 (66.3%) were prescribed ≥1 antidepressant. Compared with no antidepressants, all antidepressant classes were associated with increased relative risks of cardiovascular disorders [SSRI HR: 1.32 (1.14-1.53), TCA/Other HR: 1.26 (1.01-1.58)], and diabetes (any type) [SSRI HR: 1.28 (1.10-1.49), TCA/Other: 1.52 (1.19-1.94)]. All commonly prescribed antidepressants except citalopram were associated with increased mortality compared with no antidepressants. However, prescription ≥1 year of ≥40mg citalopram was associated with increased mortality and falls/fractures and ≥1 year 100mg sertraline with increased falls/fractures.
In overweight/obese people with depression, antidepressants may be overall and differentially associated with increased risks of some adverse outcomes. Further research is required to exclude indication bias and residual confounding.
肥胖、抑郁障碍和抗抑郁药物与死亡率增加、心血管疾病、糖尿病、骨折和跌倒有关。我们探讨了超重或肥胖伴抑郁人群中最常开的抗抑郁药与结局的相关性。
我们从英国临床实践研究数据链接（2000 年 1 月 1 日至 2016 年 12 月 31 日）中确定了一个超重或肥胖（≥18 岁）成年人的队列，这些人在初级保健中出现了新的抑郁，随访至 2019 年 1 月。使用 Cox 比例风险模型和 99%置信区间来估计与选择性 5-羟色胺再摄取抑制剂（SSRIs）、三环（TCA）/其他、联合抗抑郁药、西酞普兰、氟西汀、舍曲林、阿米替林和米氮平暴露相关的死亡率、心血管疾病、糖尿病和跌倒/骨折的风险比（HR），并调整了潜在混杂变量。在 519513 名成年人中，32350 人（每 1000 人年 9.2 人）出现了新的抑郁，21436 人（66.3%）至少开了一种抗抑郁药。与未用抗抑郁药相比，所有抗抑郁药类别均与心血管疾病风险增加相关[SSRIs HR：1.32（1.14-1.53），TCA/Other HR：1.26（1.01-1.58）]，且与糖尿病（任何类型）相关[SSRIs HR：1.28（1.10-1.49），TCA/Other：1.52（1.19-1.94）]。与未用抗抑郁药相比，除西酞普兰外，所有常用抗抑郁药均与死亡率增加相关。然而，≥1 年≥40mg 西酞普兰的处方与死亡率和跌倒/骨折增加相关，≥1 年 100mg 舍曲林与跌倒/骨折增加相关。
在超重/肥胖伴抑郁的人群中，抗抑郁药可能与某些不良结局的风险增加总体上和不同地相关。需要进一步的研究来排除适应证偏倚和残留混杂。
