AN increasing number of Brits are taking antidepressants as long term maintenance.
While little is known of the real long-term effects of the pills antidepressant prescribing in England continue to rise each year.
A new study has found the use of antidepressants could increase the risk of heart disease.
然而, experts have warned people not to stop taking the drugs.
Researchers at the University of Bristol found “concerning associations” between taking the pills over ten years and increases in 心脏疾病, death from cardiovascular disease and earlier death from any cause.
The experts said they could not be sure it was not 沮丧 itself pushing up the risks of heart issues – which was echoed by other experts who said people should not be alarmed by the findings.
The scientists looked at eight antidepressants including selective serotonin reuptake inhibitors (SSRIs) citalopram, sertraline, fluoxetine and paroxetine.
They also looked at four other antidepressants: mirtazapine, venlafaxine, duloxetine and trazodone.
SSRIs were the most commonly prescribed antidepressant, with other 80 per cent of the group taking one of the drugs.
People taking antidepressants were compared with those not on the drugs.
Following up after 10 年, those on SSRIs had a 34 per cent increased risk of heart disease, an almost doubled risk of cardiovascular death.
They also had a 73 per cent higher chance of death from any cause.
For the other antidepressants, all the risks were around double.
The researchers said: “Antidepressants, and especially SSRIs, may have a good safety profile in the short term, but are associated with adverse outcomes in the long term.
“This is important because most of the substantial increase in prescribing in the past 20 or more years is in long-term repeat prescribing.”
The study also found that antidepressants, and particularly SSRIs, were associated with a 23 per cent to 32 per cent lower risk of developing high blood pressure 和 糖尿病, though more research is needed.
Dr Narinder Bansal, the study’s lead author, said people should not stop taking their drugs suddenly and should speak to their GP if concerned.
“While we have taken into account a wide range of pre-existing risk factors for cardiovascular disease, including those that are linked to depression such as excess weight, 抽烟, and low physical activity, it is difficult to fully control for the effects of depression in this kind of study.
“This is partly because there is considerable variability in the recording of depression severity in primary care,” 他说.
他补充说: “This is important because many people taking antidepressants such as mirtazapine, venlafaxine, duloxetine and trazodone may have a more severe depression.
“This makes it difficult to fully separate the effects of the depression from the effects of medication
“Further research is needed to assess whether the associations we have seen are genuinely due to the drugs, and if so, why this might be,” 他说.
The experts said that clinicians must be aware that prescribing of antidepressants in the long term “may not be harm-free.”
They called for “proactive cardiovascular monitoring” in patients who are on antidepressants long term, “given that both have been associated with higher risks”.
Glyn Lewis, professor of psychiatric epidemiology at University College London (伦敦大学学院), said that people should not be “alarmed or worried” by the findings, or stop taking their medication.
He said the study could not conclude whether it was depression increasing health risks or the use of antidepressants.
“There is a lot of evidence, from other research, 那 depression is associated with increased cardiovascular disease,“ 他说.
“Clearly, there’s behavioural things (associated with depression), where people might not look after themselves as well.
“There may also be hormonal changes and metabolic changes which might increase risk of physical illnesses in the longer term,” 他加了.
Prof Glyn said experts should remain alert to the possible long-term effects of antidepressants as they are a commonly used drug, but he added: “We wouldn’t want people to stop their medication on the basis of this kind of result.
“These results on their own should not lead to people thinking they should stop their antidepressants. This kind of study isn’t robust enough to be able to make that kind of conclusion.”
Professor Martin Marshall, chairman of the Royal College of GPs, 说: “Existing evidence shows that antidepressants can be an effective treatment for the distressing and often-debilitating symptoms of anxiety and depression when used appropriately.
“GPs are highly trained to have open and sensitive conversations with their patients, and when discussing mental health concerns they will consider various treatment options based on the unique needs of the patient.
“If prescribing antidepressants, it will generally be at the lowest dose and for the shortest amount of time.
“This is an interesting study and as outlined by the authors, further research is needed in this area.
“然而, it’s really important that patients do not stop taking their prescribed antidepressants as a result of this research, but if they are concerned, they should discuss this at their next medication review,” 他解释说.
Professor Carmine Pariante, from the Royal College of Psychiatrists, 说: “Long-term use of antidepressants should only be considered for people that have recurrent depression and repeated, severe relapses after stopping antidepressants.
“For those patients, the beneficial effects of continuous use of antidepressants are more likely to balance the potential risks.”
NHS figures published in July showed that 8.3 million patients received antidepressants in 2021/22 在英国 – 一种 6 per cent rise from 7.9 million the previous year.
同时, The Sun revealed that more than a million prescriptions for anti-depressants were handed to teenagers last year.
在 2019, research looking at around 1,000 existing studies, published in JAMA Psychiatry, concluded that antidepressants are generally safe.