Zanimivo - Pot k sebi
Pospešeno staranje povzročajo tudi antidepresivi
Mnogi problemi, ki so povezani s
staranjem – padci, nemir, povečano tveganje za kapi in infarkte –
so direktna posledica jemanja predpisanih zdravil. Sedaj so se na tej
listi znašli tudi SSRI antidepresivi. SSRI je kratica za zdravila,
ki vsebujejo aktivno učinkovino, ki je selektivni zaviralec
seratonina, med njimi je tudi slavni Prozac.
Antidepresivi se pogosto predpisujejo
starejšim osebam, da bi se lažje spopadale z depresijo. V spodnji
študiji pa so ugotovili, da so prav ta zdravila kriva za mnoge
simptome pospešenega staranja.
Antidepresivi, posebej še SSRI,
povzročajo predčasne kapi, padce in posledično zlome, epileptične
napade, hiponatremijo (povečano vsebnost soli v krvi).
Raziskava je zajela 60746 pacientov
starih 65 let ali več in so depresivni (diagnoza). Od teh jih 89 %
jemlje antidepresive in od teh jih 57% jemlje SSRI antidepresive.
SSRI antidepresivi, ki naj bi bili
najbolj nevarni so: trazodone, mirtazapine in venlafaxine.
Najnevarnejše obdobje je prvih 28 dni in 28 dni po prenehanju
Spodaj je pripet še celotni članek,
ker so ga avtorji radodarno ocenili kot Open Source.
(Vir: British Medical Journal, 2011;
Komentar: V ZDA že dolgo uporabljajo
fototerapijo proti depresiji. Kaj je fototerapija: ljudje sedijo v
prostorih z močno lučjo, ki posnema naravno sončevo svetlobo. Če
si tega ne morete privoščiti, pa brž na sonce, za pogumnejše pa
še Sončna joga (menda že sama po sebi uravnava nivo seratonina).
BMJ 2011; 343:d4551 doi:
10.1136/bmj.d4551 (Published 2 August 2011)
Cite this as: BMJ
Antidepressant use and risk
of adverse outcomes in older people: population based cohort
Carol Coupland, associate
professor in medical statistics1, Paula Dhiman, research
statistician1, Richard Morriss, professor of psychiatry and community
mental health2, Antony Arthur, associate professor in elder care3,
Garry Barton, senior lecturer in health economics4, Julia
Hippisley-Cox, professor of clinical epidemiology and general
+ Author Affiliations
1Division of Primary Care,
University of Nottingham, Nottingham NG7 2RD, UK
Psychiatry, University of Nottingham
3Division of Nursing,
University of Nottingham
4Health Economics Group (HEG), School of
Medicine, Health Policy and Practice, University of East Anglia,
Correspondence to: C
Accepted 13 June 2011
Objectives To investigate the
association between antidepressant treatment and risk of several
potential adverse outcomes in older people with depression and to
examine risks by class of antidepressant, duration of use, and dose.
Design Cohort study of people aged 65 and
over diagnosed as having depression.
Setting 570 general practices in the United Kingdom supplying data to the
QResearch primary care database.
Participants 60 746 patients diagnosed as having a new episode of depression
between the ages of 65 and 100 years from 1 January 1996 to 31
December 2007 and followed up until 31 December 2008.
outcome measures Hazard ratios associated with
antidepressant use for all cause mortality, attempted suicide/self
harm, myocardial infarction, stroke/transient ischaemic attack,
falls, fractures, upper gastrointestinal bleeding, epilepsy/seizures,
road traffic accidents, adverse drug reactions, and hyponatraemia,
adjusted for a range of potential confounding variables. Hazard
ratios were calculated for antidepressant class (tricyclic and
related antidepressants, selective serotonin reuptake inhibitors,
other antidepressants), dose, and duration of use and for commonly
prescribed individual drugs.
Results 54 038
(89.0%) patients received at least one prescription for an
antidepressant during follow-up. A total of 1 398 359
antidepressant prescriptions were issued: 764 659 (54.7%) for
selective serotonin reuptake inhibitors, 442 192 (31.6%) for
tricyclic antidepressants, 2203 (0.2%) for monoamine oxidase
inhibitors, and 189 305 (13.5%) for the group of other
antidepressants. The associations with the adverse outcomes differed
significantly between the antidepressant classes for seven outcomes.
Selective serotonin reuptake inhibitors were associated with the
highest adjusted hazard ratios for falls (1.66, 95% confidence
interval 1.58 to 1.73) and hyponatraemia (1.52, 1.33 to 1.75)
compared with when antidepressants were not being used. The group of
other antidepressants was associated with the highest adjusted hazard
ratios for all cause mortality (1.66, 1.56 to 1.77), attempted
suicide/self harm (5.16, 3.90 to 6.83), stroke/transient ischaemic
attack (1.37, 1.22 to 1.55), fracture (1.64, 1.46 to 1.84), and
epilepsy/seizures (2.24, 1.60 to 3.15), compared with when
antidepressants were not being used. Tricyclic antidepressants did
not have the highest hazard ratio for any of the outcomes.
Significantly different associations also existed between the
individual drugs for the same seven outcomes; trazodone (tricyclic
antidepressant), mirtazapine, and venlafaxine (both in the group of
other antidepressants) were associated with the highest rates for
some of these outcomes. Absolute risks over 1 year for all cause
mortality were 7.04% for patients while not taking antidepressants,
8.12% for those taking tricyclic antidepressants, 10.61% for
selective serotonin reuptake inhibitors, and 11.43% for other
serotonin reuptake inhibitors and drugs in the group of other
antidepressants were associated with an increased risk of several
adverse outcomes compared with tricyclic antidepressants. Among
individual drugs, trazodone, mirtazapine, and venlafaxine were
associated with the highest risks for some outcomes. As this is an
observational study, it is susceptible to confounding by indication,
channelling bias, and residual confounding, so differences in
characteristics between patients prescribed different antidepressant
drugs that could account for some of the associations between the
drugs and the adverse outcomes may remain. Further research is needed
to confirm these findings, but the risks and benefits of different
antidepressants should be carefully evaluated when these drugs are
prescribed to older people.
thank the practices and patients who provide data to QResearch. This
project was funded by the NIHR Health Technology Assessment Programme
(project number 06/42/01) and will be published in full in Health
Technology Assessment. Further information about the project is
available on the HTA programme website (www.hta.ac.uk/).
Contributors: CC was involved in the conception and design of the
study, analysing and interpreting data, and reviewing the literature;
she wrote the draft manuscript. PD was involved in the design of the
study, statistical analysis, interpreting data, and reviewing the
literature. RM and AA were involved in the conception and design of
the study, interpretation of data, and reviewing the literature. GB
was involved in interpretation of data and reviewing the literature.
JH-C was involved in the conception and design of the study,
extracted the data, and was involved in interpretation of data and
reviewing the literature. All authors critically reviewed the paper.
CC is the guarantor.
Funding: This project was funded by the NIHR
Health Technology Assessment Programme (project number 06/42/01). The
views and opinions expressed are those of the authors and do not
necessarily reflect those of the Department of Health.
interests: All authors have completed the Unified Competing Interest
form at www.icmje.org/coi_disclosure.pdf (available on request from
the corresponding author) and declare: all authors had financial
support from the NIHR Health Technology Assessment Programme (project
number 06/42/01) for the submitted work; no financial relationships
with any organisations that might have an interest in the submitted
work in the previous three years; JH-C is director of QResearch,
which is a not for profit venture between the University of
Nottingham and EMIS (commercial supplier of general practice clinical
computer systems), and director of ClinRisk Ltd (medical software
company); RM has received financial support for speaking at meetings
sponsored by several pharmaceutical companies about the non-drug
treatment of depression and bipolar disorder; no other relationships
or activities that could appear to have influenced the submitted
Ethical approval: The project was independently peer
reviewed by the QResearch Scientific Board and has been reported to
Trent Research Ethics Committee in accordance with the agreed
Data sharing: The patient level data from the
QResearch databases are specifically licensed according to the
governance framework. See www.qresearch.org for further details.
This is an open-access article distributed under the terms of
the Creative Commons Attribution Non-commercial License, which
permits use, distribution, and reproduction in any medium, provided
the original work is properly cited, the use is non commercial and is
otherwise in compliance with the license. See: