Tricyclic May Raise Risk of Ischemic Heart Disease

Article excerpt

DURBAN, SOUTH AFRICA -- Use of the antidepressant dothiepin appears to be a risk factor for subsequent ischemic heart disease, Dr. Julia Hippisley-Cox reported at WONCA 2001, the conference of the World Organization of Family Doctors.

Dothiepin is a tricyclic antidepressant that was never approved for use in the United States but is widely prescribed throughout Europe.

The good news is that the same population-based case-control study that identified dothiepin as a likely contributor to ischemic heart disease (IHD) failed to implicate any other antidepressant drugs.

No increased risk of IHD was found in users of selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, or tricyclic antidepressants other than dothiepin, said Dr. Hippisley-Cox of the University of Nottingham (England).

She reported on 933 patients in a general practice research network who received a new diagnosis of IHD during a 5-year period, as well as 5,516 control subjects matched for age and gender who were free of IHD in the same 5-year period.

Among patients with IHD, 23% had ever been on antidepressant medication beforehand, compared with 16% of patients in the control group. Patients who received their first prescription for an antidepressant less than 1 year prior to diagnosis of IHD were excluded on the grounds that prodromal symptoms of IHD can sometimes resemble depression.

After adjusting for smoking, hypertension, body mass index, and diabetes, a multivariate logistic regression analysis determined that previous usage of a tricyclic antidepressant was, in fact, associated with a 60% increase in risk of subsequent IHD. …