January 8, 2010

Friday, January 08, 2010
“The Women's Health Initiative (WHI) of the National Institutes of Health followed more than 160,000 postmenopausal U.S. women for up to 15 years, examining risk factors for and potential preventive measures against cardiovascular disease, cancer and osteoporosis.”

The researchers collected data from 136,000 participants that were not taking antidepressant medications when they first began the study. It was noted during their first follow up between one and three years later that roughly 5,500 of those women had begun taking antidepressants. “The research team compared that group's subsequent history of cardiovascular disease with that of participants who had not started taking antidepressants.”

Results showed that the women taking antidepressants had a small, but statistically significant increased risk of stroke and/or death compared to participants declaring that they were not taking antidepressants.

Lead author, Jordan W. Smoller, MD, ScD, of the Massachusetts General Hospital (MGH) Department of Psychiatry, explains that although it is necessary to treat depression because it is a serious illness, it is equally important for older women to discuss their treatment options with their physician before committing to one because of the various risks involved.

The DSM IV defines depression as experiencing feelings of sadness, helplessness and hopelessness. It is a state of low mood and aversion to activity. Episodes of depressed mood are a core feature in various psychological disorders.

Some symptoms of depression can include:
  • Anxiety
  • Sleep disturbances
  • never seem to be enough
  • dullness
  • chronic sadness never seeming to end
  • obsessions
  • shakiness when feeling most down
  • mood swings
Medications used to treat depression:

Tricyclic antidepressants
  • Amitriptyline
  • Imipramine
  • Nortriptyline
  • Desipramine

  • Side effects: Fatigue, dry mouth, blurred vision, light-headedness
Selective serotonin-reuptake inhibitors (SSRI)
  • Fluoxetine
  • Fluvoxamine
  • Sertraline
  • Paroxetine

  • Side effects: Nausea, gastrointestinal upset, sleep disturbances, headache, agitation
Reversible inhibitors of monoamine oxidase:
  • Moclobemide

  • Side effects: Insomnia, headache, constipation
5-HT2 antagonists:
  • Nefazodone

  • Side effects: Fatigue, light-headedness, nausea, headache
Serotonin-norepinephrine reuptake inhibitors:
  • Venlafaxine

  • Side effects: Nausea, agitation, sweating
MAOIs (monoamine oxidase inhibitors):
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
  • Isocarboxazid (Marplan)
  • Selegiline (Emsam)

  • Side effects: Drowsiness, Constipation, Nausea, Diarrhea, Stomach upset, Fatigue, Dry mouth, Dizziness, Low blood pressure, Light-headedness, Decreased urination, Decreased sexual function, Sleep disturbances, Muscle twitching, Weight gain, Blurred vision, Headache, Increased appetite, Restlessness, Shakiness, Trembling, Weakness, Increased sweating
“Depression is a known risk factor for cardiovascular disease and premature death, and one of the reasons that tricyclic antidepressants are used less frequently is their potential for negative effects on heart function. Selective serotonin reuptake inhibitor (SSRI) antidepressants have fewer side effects in general and are known to have aspirin-like effects on bleeding, which could protect against clot-related cardiovascular disorders.”

Although no relationship was established between antidepressant use and heart disease, follow-up appointments nearly six years later indicated that participants using antidepressants had an increased risk of death and those treated with SSRIs had an increased risk of stroke.

Even though results seem frightening it seems to me that further investigation is needed as there are several problems with this study. The researchers have not distinguished whether the problem really lies within the link between antidepressants and cardiovascular disease or depression itself and cardiovascular disease. Prior studies will show that depression has risks that are just as high as those who use antidepressants in this study. If anything, the study may indicate that treatment with antidepressants could exacerbate those risks. After careful review of this study, it seems difficult to place blame on antidepressants, but more could be revealed with further investigation.

Additionally, the study does not specify whether these women were being treated for depression or for anxiety nor is there any indication that lifestyle factors such as stress, smoking or diet have been accounted for. Furthermore, the study is too group-specific; therefore it cannot suggest that results can be generalized to the other populations, such as men or premenopausal women unfortunately.

Despite the lack of concrete evidence, it seems logical that women with cardiovascular risks would benefit from exploring treatment options other than antidepressants, but in the end, for most, the benefits of antidepressants may far outweigh the costs.

Increased Risk of Death, Stroke in Postmenopausal Women Taking Antidepressants, Study Finds
Monoamine Oxidase Inhibitors
Medications for Treating Depression

© www.mentalhealthblog.com

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Murfomurf said...

As a post-menopausal woman who has been depressed most of my life and on various antidepressants for 20 years, I can understand how antidepressant use might seem related to CVD. I think there are too many confounding factors to conclude the increased CVD is actually due to the medication use. The problem with treated depression is firstly that most people are not treated optimally, and certainly not optimally all the time. Secondly, many antidepressants cause weight gain (quite rapid at first eg 5 to 10 kgs in a few months)- very bad for CVD, since this weight is rarely lost again in your lifetime. Even further, depression (and some anti depressants themselves,)makes people less active- many depressives (including myself) may spend large amounts of time each day for months or years hiding away in bed or immobilised on the sofa doing very little. It is very hard to get involved in any gym or walking programs because of the feelings of isolation, fear of bursting into tears and fear of not being accepted by others. I actually fear death from stroke or accelerated heart disease because of my depression and deliberately try to get moving once every hour while awake, but I doubt many others do this! I think special programs of phone reminders to exercise would work wonders as part of depression therapy, just as they ought to work with ordinary people who lack motivation to control their weight or eating.

meg said...

Hi Murfomurf, thank you for your comment. You make some very interesting and valid points. In most cases, causation is very hard to determine, however often times different aspects may be correlated in some way. I think you may have touched on some correlations that need further investigation.

I would love to hear your opinion on other topics as well. Thanks again for your contribution!

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