Geriatric Department, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France.
Normandie Univ, UNICAEN, INSERM COMETE, U1075, F-14000, Caen, France.
BMC Geriatr. 2024 Jul 12;24(1):600. doi: 10.1186/s12877-024-05022-0.
Psychoactive drugs frequently cause delirium adverse events in older adults. However, few data on the relationship between antidepressants and delirium are available. Here, we investigated the association between antidepressant prescription and pharmacovigilance reports of delirium in older adults.
Using the World Health Organization's VigiBase® global pharmacovigilance database from 1967 to 2022, we performed a disproportionality analysis in order to probe the putative associations between each antidepressant class (non-selective monoamine reuptake inhibitors (NSMRIs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), alpha-2-adrenergic receptor antagonists, and other antidepressants) and reports of delirium in people aged 65 or over. We calculated the reporting odds ratios (r-OR) and their 95% confidence interval ([95%CI]) with logistic regression models before and after adjustment for confounding factors. Secondary analyses were performed for each drug and within each class by age group (65-74, and 75 and over). We also studied the reports of concomitant delirium and hyponatremia.
Our main analysis included 87,524 cases of delirium. After adjustment for confounders, a significant association was found between delirium and all antidepressant classes other than SNRIs. Intraclass disparities were found for the association between the most frequently prescribed antidepressants and reports of delirium. An elevated risk of reports of concomitant delirium and hyponatremia was found for SSRIs (4.46 [4.01-4.96]), SNRIs (1.25 [1.07-1.46]), MAOIs (1.72 [1.41-2.09]), and the "other antidepressants" class (1.47 [1.30-1.65]).
There was a significant association between reports of delirium and antidepressant classes (other than SNRIs). However, this association varied from one drug to another within a given antidepressant class. Moreover, this association could not always be explained by antidepressant-induced hyponatremia.
精神活性药物经常会导致老年人出现谵妄不良事件。然而，关于抗抑郁药与谵妄之间关系的数据很少。在这里，我们研究了抗抑郁药处方与老年人谵妄药物警戒报告之间的关系。
我们使用世界卫生组织的全球药物警戒数据库（VigiBase®）从 1967 年至 2022 年的数据，进行了一项比例失衡分析，以探究每个抗抑郁药类别（非选择性单胺再摄取抑制剂（NSMRIs）、选择性 5-羟色胺再摄取抑制剂（SSRIs）、5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）、单胺氧化酶抑制剂（MAOIs）、α-2-肾上腺素能受体拮抗剂和其他抗抑郁药）与 65 岁及以上人群谵妄报告之间的潜在关联。我们使用逻辑回归模型计算了报告比值比（r-OR）及其 95%置信区间（95%CI），并在调整混杂因素前后进行了分析。在每个药物类别中，我们还按年龄组（65-74 岁和 75 岁及以上）进行了二次分析。我们还研究了同时发生的谵妄和低钠血症的报告。
我们的主要分析包括 87524 例谵妄病例。在调整混杂因素后，除 SNRIs 外，所有其他抗抑郁药类别均与谵妄显著相关。最常开的抗抑郁药与谵妄报告之间的关联存在类内差异。SSRIs（4.46 [4.01-4.96]）、SNRIs（1.25 [1.07-1.46]）、MAOIs（1.72 [1.41-2.09]）和“其他抗抑郁药”类别（1.47 [1.30-1.65]）与同时发生的谵妄和低钠血症报告的风险增加相关。
谵妄报告与抗抑郁药类别（除 SNRIs 外）之间存在显著关联。然而，这种关联在给定的抗抑郁药类别内从一种药物到另一种药物有所不同。此外，这种关联并不能总是用抗抑郁药引起的低钠血症来解释。
