Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China.
Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
Sci Rep. 2021 Jun 28;11(1):13365. doi: 10.1038/s41598-021-92807-7.
There is a large amount of evidence that selective serotonin reuptake inhibitors (SSRIs) are related to cardiovascular toxicity, which has aroused concern regarding their safety. However, few studies have evaluated the effects of SSRIs on cardiac injury biomarkers, such as creatine kinase (CK) and creatine kinase isoenzyme (CK-MB). The purpose of our study was to determine whether SSRIs elevated CK and CK-MB levels of prior medicated depressive patients (PMDP) compared to first-episode drug-naïve depressive patients (FDDPs). We performed an observational and retrospective study involving 128 patients with major depressive disorder. Patients who had never used any type of antidepressant were designated FDDP; patients who had used only one type of SSRI but were not treated after a recent relapse were designated PMDP. Serum CK and CK-MB levels were measured before and after using SSRIs for a period of time. The duration of current treatment in the FDDP and PMDP groups was 16.200 ± 16.726 weeks and 15.618 ± 16.902 weeks, respectively. After SSRI treatment, levels of serum CK in the PMDP group were significantly higher than in the FDDP group. Univariate ANCOVA results revealed that PMDP was 22.313 times more likely to elevate CK (OR 22.313, 95% CI 9.605-35.022) and 2.615 times more likely to elevate CK-MB (OR 2.615, 95% CI 1.287-3.943) than FDDP. Multivariate ANCOVA revealed an interaction between the group and sex of CK and CK-MB. Further pairwise analysis of the interaction results showed that in female patients, the mean difference (MD) of CK and CK-MB in PMDP was significantly greater than that in FDDP (MD = 33.410, P = 0.000, 95% CI 15.935-50.886; MD = 4.613, P = 0.000, 95% CI 2.846-6.381). Our findings suggest that patients, especially females, who had previously used SSRI antidepressants were more likely to have elevated CK and CK-MB, indicators of myocardial muscle injury. Use of SSRIs should not be assumed to be completely safe and without any cardiovascular risks.
有大量证据表明，选择性 5-羟色胺再摄取抑制剂（SSRIs）与心血管毒性有关，这引起了人们对其安全性的关注。然而，很少有研究评估 SSRIs 对心脏损伤生物标志物（如肌酸激酶（CK）和肌酸激酶同工酶（CK-MB）的影响。我们的研究目的是确定与首次发作的药物-naive 抑郁患者（FDDP）相比，SSRIs 是否会升高先前接受药物治疗的抑郁患者（PMDP）的 CK 和 CK-MB 水平。我们进行了一项观察性和回顾性研究，涉及 128 名患有重度抑郁症的患者。从未使用过任何类型抗抑郁药的患者被指定为 FDDP；仅使用过一种 SSRI 但在最近复发后未接受治疗的患者被指定为 PMDP。在使用 SSRIs 一段时间后，测量患者的血清 CK 和 CK-MB 水平。FDDP 和 PMDP 组的当前治疗持续时间分别为 16.200±16.726 周和 15.618±16.902 周。在 SSRI 治疗后，PMDP 组的血清 CK 水平明显高于 FDDP 组。单因素协方差分析结果显示，PMDP 使 CK 升高的可能性增加了 22.313 倍（OR 22.313，95%CI 9.605-35.022），使 CK-MB 升高的可能性增加了 2.615 倍（OR 2.615，95%CI 1.287-3.943）。多因素协方差分析显示，组与 CK 和 CK-MB 的性别之间存在交互作用。对交互作用结果的进一步两两分析表明，在女性患者中，PMDP 的 CK 和 CK-MB 均值差值（MD）明显大于 FDDP（MD=33.410，P=0.000，95%CI 15.935-50.886；MD=4.613，P=0.000，95%CI 2.846-6.381）。我们的研究结果表明，与首次发作的药物-naive 抑郁患者（FDDP）相比，先前使用过 SSRI 类抗抑郁药的患者（PMDP）更有可能出现 CK 和 CK-MB 升高，这是心肌损伤的指标。因此，不能认为 SSRI 的使用是完全安全的，没有任何心血管风险。
