Worried about new study on AD's can others comment or offer advice on it please

[owainm]

There was a new study published last week

https://www.bristol.ac.uk/news/2022/...ant-study.html

It has got me very worried as I've been on an AD for 20 plus years (seroxat for 18) and fluoxetine for the last few. Im now in a state of panic that Im going to drop dead from a heart attack. Just wondering if anyone else has seen this and what others may think of it. Please any comments or advice as Im freaking out over this thanks Owain

[panic_down_under]

Never take the findings of one study as proof of anything.

This is an observational study which took data from a patient database looking for an association between ADs and cardiovascular disease and all case mortality. The problem is anxiety/depression/stress are themselves by far the leading cause of premature death which makes it difficult in this case to determine whether the cause of a death was the ADs or the disorder it was being taken for and the disorder's impact on health. The authors have tried to account for many of the potential non med causes, but there is a lot of guessing involved. Change some of the confounding adjustments even slightly and the results could be vastly different.

There are also a number of other issues, including:

The dataset did not include dosing information, so this had to be estimated.

Adverse events were assigned to a med from when the first prescription was filled so if the patient had a heart attack the next day responsibility was assigned to the AD. So how did they determine whether the med was actually taken straight away? Ime, many just stare at the box for some days, even weeks, before taking the first dose and some never take it at all, but claim they did.

They didn't have enough patients in the selected cohort to compare outcomes in short and long term med use.

One indication that the study results need to be treated with considerable caution is that it found that SSRIs reduce two of the leading cardiovascular risk factors, high BP and diabetes onset, yet supposedly they increase adverse events??

The authors themselves say that the results need to be taken with caution. From the study's 'Clinical implications' section:

Since this is an observational study, our findings do not imply causality, and highlight the importance of further work to investigate and elucidate potential mechanisms. [my emphasis]

I also urge you to read the study and especially the "Strengths and limitations" section.

[owainm]

Hi thanks for the reply. I'm in a very bad palce just now and this article has just made me worse. I'm worried now that I may have or will get heart damage from my meds. Plus the fact I'm likely to be on them for life has got me scared.

This study https://www.bmj.com/content/352/bmj.i1350 seems to state the opposite to the new one (the new one does cite it but says its is flawed? I don't understand how?

[panic_down_under]

I'm worried now that I may have or will get heart damage from my meds. Plus the fact I'm likely to be on them for life has got me scared.

SSRIs have been in use for 33 years with hundreds of millions having taken them, some continually for much of that time. If this was a significant issue it would have become apparent in the clinical setting. It hasn't as far as I know. Indeed, SSRIs are often prescribed to heart attack and stroke survivors by cardiologists to treat the anxiety and/or depression which often follows.

Your biggest risk factor isn't the med you're taking, but the disorder/s it is treating. Anxiety/depression/stress is by far the leading cause of premature death as they raise the risk of developing cardiovascular disease, diabetes, cancers and other conditions which shorten lives. You can greatly reduce your risk by eating a healthy diet, exercising regularly and having at least annual medical check ups, including an ECG/EKG.

This study https://www.bmj.com/content/352/bmj.i1350 seems to state the opposite to the new one (the new one does cite it but says its is flawed? I don't understand how?

Both are based on general patient data bases, not data specifically about ADs, or anxiety and depression. The data had to be significantly 'massaged' by algorithms developed by each of the study authors to eliminate confounding causes. The authors of the more recent paper claim the authors of the first didn't take into account all the factors they consider relevant so the study is flawed. Are they correct? I don't know. This is far from an exact science and there are almost certainly flaws in both. The authors of the recent study admit as much throughout the paper which is why I urged you to read it in full. They also make it clear that their findings do not prove causation and state more research is needed.

Both studies are interesting, but fall far short of proving SSRIs are either safe, or dangerous.

[tn13]

I feel like this is probably a correlation does not equal causation situation. Antidepressants are prescribed to people with depression and anxiety. Those conditions cause stress, which isn't good for the heart, and also drive behaviours like alcohol use, smoking, indulging in food, etc that then lead to heart disease.