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Meta-Analysis
. 2015 May-Jun;47(3):256-62.
doi: 10.4103/0253-7613.157112.

Impact of antidepressants use on risk of myocardial infarction: A systematic review and meta-analysis

Krishna Undela  1 , Gurumurthy Parthasarathi  1 , Sharon Sunny John  1
Affiliations
Meta-Analysis

Impact of antidepressants use on risk of myocardial infarction: A systematic review and meta-analysis

Krishna Undela et al. Indian J Pharmacol. 2015 May-Jun.

Abstract

Aims: The aim of the study was to perform a systematic review and meta-analysis to determine the association between antidepressants use and risk of myocardial infarction (MI), and whether this association differs between tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).

Methods: A PubMed/MEDLINE search was conducted for studies published up to December 2013. Included studies were evaluated for publication bias and heterogeneity. Depending on the presence of heterogeneity, a random or fixed effects model was used to identify the pooled relative risk (RR) with 95% confidence intervals (CIs). Cumulative meta-analysis, subgroup and sensitivity analyses were also performed. All analyses were performed using comprehensive meta-analysis software.

Results: Fourteen (five cohort and nine case-control) studies were included. There was heterogeneity among the studies (P heterogeneity = 0.02; I (2) = 68%) but no publication bias (Begg's P = 0.30 and Egger's P = 0.45). Antidepressants use significantly increases the risk of myocardial infarction (MI) (RR = 2.03; 95% CI = 1.30-3.18; P < 0.01). On subgroup analysis by study design, cohort studies show significant positive association (RR = 2.16; 95% CI = 1.42-3.29; P < 0.01), but not case-control studies (RR = 2.47; 95% CI = 0.69-8.90; P = 0.17). Sensitivity analysis and cumulative meta-analysis confirmed the stability of results. TCAs users are having 36% increased risk of MI after excluding one outlier (RR = 1.36; 95% CI = 1.10-1.67; P < 0.01), but SSRIs showing no association (RR = 0.84; 95% CI = 0.57-1.22; P = 0.35).

Conclusions: We found evidence that the use of antidepressants was associated with elevated risk of MI. Further research is needed to identify the underlying biological mechanisms.

Keywords: Myocardial infarction; selective serotonin reuptake inhibitors; tricyclic antidepressants.

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Conflict of interest statement

Conflict of Interest: No.

Figures

Figure 1
Figure 1
Flowchart representing the selection process of studies
Figure 2
Figure 2
Forest plot representing the association between antidepressannats, selective serotonin reuptake inhibitors and tricyclic antidepressants use and risk of myocardial infarction. The square size is proportional to the weight of the corresponding in the meta-analysis; the length of horizontal line represents the 95% confidence interval (CI); the diamond indicates the pooled relative risk with 95% CI (random effects model)
Figure 3
Figure 3
Sensitivity analysis of studies with tricyclic antidepressants use and risk of myocardial infarction
See this image and copyright information in PMC

References

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