June 27, 2018
Older adult patients with chronic obstructive pulmonary disease (COPD), who are prescribed antidepressants, have an increased risk of death and hospitalizations due to related symptoms, according to a new study published in the European Respiratory Journal.
The research team at St Michael’s Hospital led by Nicolas Vozoris, MD, and colleagues, identified 131,718 physician-diagnosed patients with COPD, ages 66 years and older, in a retrospective, population-based, cohort study using heath administrative data from Ontario, Canada. Of these patients, 28,360 were new users of serotonergic antidepressants.
According to the findings, patients using serotonergic antidepressants—a specific class of the medication—had higher rates of hospitalization, emergency room visits, and mortality related to respiratory conditions, as well as death overall versus non-users of the medications. The researchers found that new users of the antidepressants compared to non-users had significantly higher rates of hospitalization for COPD or pneumonia (hazard ratio [HR] 1.15; 95% confidence interval [CI] 1.05–1.25), ER visits for COPD or pneumonia (HR 1.13; 95% CI 1.03–1.24), COPD or pneumonia-related mortality (HR 1.26; 95% CI 1.03–1.55) and all-cause mortality (HR 1.20; 95% CI 1.11–1.29). Further, respiratory-specific and all-cause mortality rates were also higher among long-term care home residents who were new users of antidepressant drugs versus controls.
“We were not surprised by these findings, as there are biological reasons why antidepressants could lead to respiratory issues,” Dr Vozoris explained in a press release. “These drugs can cause sleepiness, vomiting and can negatively impact immune system cells. This increases the likelihood of infections, breathing issues, and other respiratory adverse events, especially in patients with COPD.”
The researchers noted that this new study does not show cause and effect, but it does suggest strong association between antidepressants and COPD-related deaths and hospitalizations. According to the overall findings, the use of new serotonergic antidepressants was associated with small, but significant, increases in rates of respiratory-related morbidity and mortality among older adults with COPD.
“The study results should not cause alarm among those who use these medications, but rather increase caution among patients and physicians,” Dr Vozoris expressed in a statement. “I hope our study encourages increased awareness when prescribing these medications and monitoring for adverse side effects. Also, because there is this association, we as physicians should give thought to psychotherapy and pulmonary rehabilitation as non-drug related treatment.”
According to the researchers, further research is needed to clarify if the observed associations are causal or instead reflect unresolved confounding.
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