(Not ME/CFS-specific) "Tricyclic antidepressants 'raise cardiovascular risk'"

Dolphin

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[Quite a lot of patients with ME/CFS take these drugs. On the face of it, this is a bit worrying but patients on tricyclics may be quite ill. I haven't seen the full paper to see what they controlled for.]

http://www.pulsetoday.co.uk/story.asp?storycode=4127924

Tricyclic antidepressants 'raise cardiovascular risk'

01 Dec 10

By Lilian Anekwe

GPs have been advised to consider alternatives to tricyclic antidepressants after a UK study of 15,000 patients showed those who took the drugs had a 35% greater risk of developing cardiovascular disease than those who did not.

The increase was apparent after adjusting for psychiatric symptoms and no increase was seen with SSRIs or other antidepressants, which the researchers say suggests tricyclics are truly raising CVD risk.

Researchers analysed data from the Scottish Health Survey involving 14,784 men and women over 35, initially without CVD, and linked data - including medication use - with records on hospital admissions and deaths over an average eight years follow up.

Almost 5% of patients reported the use of antidepressant medication, of which 2.2% were taking tricyclics, 2% SSRIs and 0.7% other antidepressants.

There was a 35% increased risk of cardiovascular disease associated with tricyclic use compared to patients on no medication, after adjusting for confounding factors.

Study leader Dr Mark Hamer, senior research fellow in epidemiology and public health at University College London told Pulse GPs should consider switching any patient on tricyclics to an alternative.


'Tricyclics are also quite widely for headaches, migraines and other kinds of neurological pain. But the increased risk was not specific to what patients were being treated for. If there is an alternative option our data suggests GPs should look at it,' he said.

The study also found those taking antidepressants were more likely to smoke, be overweight and do little or no physical activity and Dr Hamer added: 'By giving up smoking, losing weight, and becoming more active a person can reduce their risk of cardiovascular disease by two to three-fold, which largely outweighs the risks of taking the medications in the first place.'

Dr John Hague, a GPSI in mental health in Ipswich said: 'NICE depression guidance is clear that GPs should consider SSRIs first line as drug therapy and there are alternatives for neuropathic pain - like gapapentin and pregabalin.'

The study did not look at antidepressant dose and Dr Hague said: 'Whether the risk is dose-dependent, is an extremely important question and we need further research into it.

Often a dose of 40-50mg is used for chronic pain but for depression the dose is typically 125 or 150mg a day. If it does apply to low doses for chronic pain then I'd be concerned.'

European Heart Journal, 1 December
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CLINICAL RESEARCH:
Mark Hamer, G. David Batty, Adrie Seldenrijk, and Mika Kivimaki Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey Eur Heart J first published online November 30, 2010
doi:10.1093/eurheartj/ehq438
 

Esther12

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They're commonly used for chronic pain and migraines now. I wonder if these conditions would be related with cardiovascular problems regardless of treatment.
 

Dolphin

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They're commonly used for chronic pain and migraines now. I wonder if these conditions would be related with cardiovascular problems regardless of treatment.
Yes. They help so many of my symptoms that I'm reluctant to stop. Of course, if the core illness was treated, I might have fewer symptoms and they'd be less severe and it'd be easier to give them up.
 
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We are supposed to be taking them in tiny doses - ie 10mg while a proper dose for depression is more like 45 - 50mg. Certainly the 10 mg gives me a great sleep - and is generally great for me. Amytriptyline saved my life as sleeping probs were terrible - I went up to 30mg at the very worst time but needed to only for a couple of weeks then reduced to 20 and then 10 again. If the research was looking at the does for depression then our lower doses are no doubt a whole lot safer.