This article discusses the causes for the rise in antidepressant prescriptions. It also explores the link between antidepressant use and chronic diseases.
The concept was inspired by RFK Jr., the new HHS secretary who wants to find the association between several conditions and chronic diseases.
JUST IN: RFK Jr. to investigate rising chronic disease:
— Libs of TikTok (@libsoftiktok) February 18, 2025
– Ultra-processed food
– Electromagnetic radiation
– Childhood vaccine schedule
– Glyphosate & pesticides
– Artificial food additives
– SSRIs & antidepressants
– Microplastics & more pic.twitter.com/ksgKHuOiGM
This is my contribution.
Antidepressant Use Worldwide
Antidepressant use has increased significantly in the United States and globally. There are notable variations across age groups and types of depression.
United States
- Prevalence: As of 2015–2018, approximately 13.2% of adults aged 18 and over reported using antidepressant medication in the past 30 days. cdc.gov
- Age and Gender Differences:
- Usage increases with age:
- 7.9% among adults aged 18–39
- 14.4% for those aged 40–59
- 19.0% for adults aged 60 and over
- Usage increases with age:
- Women are more likely to use antidepressants than men across all age groups. cdc.gov
- Trends Among Youth: Antidepressant prescriptions for adolescents and young adults have risen sharply. There has been a nearly 64% increase from 2020 onward. healthline.com
Global Perspective
- High-Consumption Countries: 2022 Iceland had the highest antidepressant consumption among selected OECD countries. The consumption was about 157 defined daily doses per 1,000 people. statista.com
- Gender Differences: Studies indicate that women are prescribed antidepressants more than men across various countries. pmc.ncbi.nlm.nih.gov
The increasing use of antidepressants highlights the growing recognition and treatment of mental health conditions worldwide.
Changes in society, the definition of depression, and laws explain the increase in antidepressant prescriptions.
Factors that Led to Higher Antidepressant Use
Significant changes have occurred over the past few decades in societal and family dynamics. There have also been changes in regulating direct-to-consumer (DTC) pharmaceutical advertising. Psychiatric organizations have also altered how they conceptualize depression.
Family Dynamics
Societal Factors
- Increased Recognition of Mental Health Issues: Greater awareness and reduced stigma surrounding mental health have grown significantly. More individuals are now seeking treatment for conditions like depression and anxiety. evidence.nihr.ac.uk
- Stressful Modern Lifestyles: Urbanization, economic pressures, and social isolation have escalated stress levels. This may increase the prevalence of mental health disorders. en.wikipedia.org
Changes in Direct-to-Consumer (DTC) Pharmaceutical Advertising Regulatory Evolution:
- In 1997, the U.S. Food and Drug Administration (FDA) issued guidelines. These guidelines relaxed earlier restrictions on DTC advertising. They allowed pharmaceutical companies to promote prescription medications directly to consumers via television and radio. This shift led to a substantial increase in pharmaceutical advertising expenditures, rising from $1.12 billion in 1998 to approximately $5.2 billion by 2016. en.wikipedia.org
- Recent Developments: In November 2023, the FDA implemented a new rule. It mandates that DTC advertisements present major statements about drug risks in a “clear, conspicuous, and neutral manner.” The goal is to enhance consumer understanding of potential side effects. federalregister.gov
Evolution in the Conceptualization of Depression
Diagnostic Criteria:
Over the past 30 years, the understanding of depression has evolved significantly. Initially, it was viewed as an episodic disorder with complete remission. Now, it is recognized as a condition with the potential for recurrence.
Follow-up studies have shown that at least 60% of hospitalized depressive patients are readmitted over 16 years. Recurrence rates for episodes of any severity reach up to 90%.
This recognition of depression’s recurrent nature has led to changes in clinical guidelines. These changes advocate for extended antidepressant therapy to prevent relapse. Current recommendations suggest continuing antidepressant treatment for 4 to 9 months after achieving remission to reduce the risk of recurrence.
Such guidelines have led to an increase in long-term antidepressant prescriptions. Clinicians aim to maintain therapeutic benefits. They also work to prevent future depressive episodes.
The Diagnostic and Statistical Manual of Mental Disorders:
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification system for mental health conditions. Psychiatrists and healthcare professionals use it to diagnose them.
It provides uniform diagnostic criteria, guides treatment decisions, and ensures consistency in mental health care. Health insurance companies rely on DSM codes for billing and reimbursement. A formal DSM diagnosis is often necessary to approve coverage for psychiatric treatments, therapy, and medications.
The DSM (Diagnostic and Statistical Manual of Mental Disorders) is periodically revised. This reflects advancements in psychiatric research and clinical practice. It also considers evolving societal understandings of mental health conditions.
Antidepressants and Medicalization
The evolution of depression definitions in the Diagnostic and Statistical Manual of Mental Disorders (DSM) has influenced antidepressant prescription rates. This effect is particularly notable with changes introduced in the DSM-5. It was published in 2013.
Removal of the Bereavement Exclusion (2013, DSM-5): Before, the DSM-IV (1994) excluded individuals experiencing grief. They were not diagnosed with major depressive disorder (MDD) within the first two months after a significant loss. The DSM-5 (2013) eliminated this exclusion, allowing a depression diagnosis even during bereavement. This change led to more prescriptions as clinicians began treating grief-related depressive symptoms with medication.
Introduction of New Disorders (2013, DSM-5): The DSM-5 added new depressive-related conditions. One example is Disruptive Mood Dysregulation Disorder (DMDD). It also officially recognized Premenstrual Dysphoric Disorder (PMDD) as a distinct diagnosis.
These definitional changes have broadened the scope of depressive disorders, allowing more individuals to be diagnosed and treated with antidepressants. This shift, along with an increased focus on early intervention, contributed to the continuous rise in antidepressant use. This increase has been observed since the DSM-5 was introduced in 2013.
Financial Conflicts of Interest
Concerns have been raised about financial ties between DSM-5 contributors and the pharmaceutical industry:
In summary, the DSM-5 revision process incorporated input from various advocacy groups. However, questions have been raised about the financial ties between task force members and the pharmaceutical industry. These relationships may influence the manual’s content.
Big Pharma Revenue Pre and Post-DSM 5
The pharmaceutical industry has experienced significant revenue from antidepressant sales. Notable growth followed the publication of the DSM-5 in 2013.
Global Antidepressant Market Growth
- Pre-DSM-5 (2012): The global antidepressant market was valued at approximately $11.67 billion.
- Post-DSM-5 (2024): The market expanded to an estimated $18.7 billion, reflecting increased awareness and diagnosis of depressive disorders. gminsights.com
Top Antidepressant Medications and Their Manufacturers
- Sertraline Hydrochloride (Zoloft): Manufactured by Pfizer, Sertraline accounted for 16.73% of total antidepressant prescriptions in 2023. definitivehc.com
- Trazodone Hydrochloride: Produced by various manufacturers, it held 15.41% of prescriptions in 2023.
- Fluoxetine (Prozac): Developed by Eli Lilly and Company, Fluoxetine comprised 12.64% of prescriptions in 2023.
Revenue Comparison
- Pre-DSM-5: In 2013, Pfizer’s Zoloft generated $469 million in U.S. sales. fiercepharma.com
- Post-DSM-5: By 2024, the U.S. antidepressant market reached $6.8 billion, with leading medications like Zoloft contributing significantly to this figure. gminsights.com
The definitional changes in depressive disorders introduced by the DSM-5 have contributed to the expansion of the antidepressant market. Broader diagnostic criteria have led to increased diagnoses. This, in turn, resulted in more prescriptions.
While antidepressants may enhance emotional well-being, how do they impact overall physical health? Let’s look at five studies.
Antidepressant Use and Chronic Diseases
1. “Antidepressant Use and Risk of Adverse Outcomes” (British Journal of Psychiatry)
This population-based cohort study examined the long-term health effects of antidepressant use. It involved 222,121 participants in the UK Biobank and linked their records to primary care data.[1]
The study analyzed the association between antidepressant use. It categorized them into Selective Serotonin Reuptake Inhibitors (SSRIs) and other antidepressants.
The study examined various morbidity outcomes, like diabetes and hypertension. It also considered coronary heart disease (CHD) and cerebrovascular disease (CV). Additionally, it looked at mortality outcomes, including cardiovascular disease (CVD) and all-cause mortality.
This analysis was over a 5-year and 10-year follow-up period using Cox’s proportional hazards model.
Key Findings
- Potential Protective Effects of SSRIs:
- SSRI use was linked with a lower risk of diabetes at 5 years. It showed a 36% lower risk. At 10 years, the risk was 32% lower.
- SSRI use was also linked to a 23% reduced risk of hypertension at 10 years.
- Increased Risk of Cardiovascular and Mortality Outcomes:
- At 10 years, SSRI use was linked with:
- 34% increased risk of cerebrovascular disease (CV).
- 87% increased risk of cardiovascular disease (CVD) mortality.
- 73% increased risk of all-cause mortality.
- ‘Other’ class antidepressants were linked to even higher risks:
- 99% increased risk of coronary heart disease (CHD).
- 86% increased risk of cerebrovascular disease (CV).
- 120% increased risk of all-cause mortality.
- At 10 years, SSRI use was linked with:
Summary
The study suggests a troubling association. Long-term antidepressant use is linked to elevated risks of cardiovascular disease (CVD) and coronary heart disease (CHD). It also highlights a risk of all-cause mortality. These risks are particularly noted at the 10-year follow-up.
Although SSRIs were linked with some protective effects against diabetes and hypertension, there are potential risks. These include cardiovascular complications and mortality, which raise concerns.
2. “Association of Antidepressant Medication Type With the Incidence of Cardiovascular Disease in the ARIC Study” (Journal of the American Heart Association)
This study explored the connection between different types of antidepressants and CVD risk. It involved 2,027 participants in the Atherosclerosis Risk in Communities (ARIC) study.[2]
The participants, who had a mean age of 63, were tracked from 1987 to 2016. The goal was to determine whether Selective Serotonin Reuptake Inhibitors (SSRIs) were linked with decreased CVD risk. The SSRIs were compared to tricyclics and other non-SSRI antidepressants.
Key Findings
- No Cardiovascular Benefit for SSRIs Over Other Antidepressants:
- The study found no significant difference in CVD risk between SSRI users (47%) and non-SSRI users (tricyclics and other antidepressants).
- The adjusted hazard ratios (HRs) showed no statistically significant difference in the incidence of:
- Atrial fibrillation (HR: 1.10; 95% CI: 0.86–1.41)
- Heart failure (HR: 0.98; 95% CI: 0.77–1.25)
- Myocardial infarction (HR: 0.91; 95% CI: 0.64–1.29)
- Ischemic stroke (HR: 1.07; 95% CI: 0.70–1.63)
- Long-Term Follow-Up Without Cardiovascular Risk Differentiation:
- Participants were followed for a median of 13.5 years, and no clear advantage was observed in CVD outcomes based on antidepressant type.
Summary
The findings show that SSRIs do not offer a protective effect against cardiovascular disease compared to tricyclics or other antidepressants.
Given the long duration of follow-up (nearly 30 years), these results suggest that choosing an SSRI over another antidepressant does not reduce the likelihood of developing atrial fibrillation.
SSRIs also do not lower the risk of heart failure, myocardial infarction, or ischemic stroke. This challenges the assumption that SSRIs are safer for cardiovascular health.
3. Antidepressant Use and Risk of Adverse Outcomes in People Aged 20-64 Years” (BMC Medicine)
This cohort study investigated the safety of antidepressant use in young and middle-aged adults (20-64 years old) diagnosed with depression.[3]
Using data from 238,963 patients in the UK QResearch primary care database, the study examined the association between antidepressant use and multiple adverse outcomes.
These included falls, fractures, gastrointestinal (GI) bleeds, road traffic accidents, adverse drug reactions, and all-cause mortality.
Key Findings
- Increased Risk of Fractures and Falls with Antidepressant Use
- SSRI users had a 30% increased risk of fractures (HR 1.30, 95% CI 1.21-1.39).
- Other antidepressant users had a 28% increased risk of fractures (HR 1.28, 95% CI 1.11-1.48).
- All antidepressant drug classes were linked with increased fall rates.
- Higher Risk of Adverse Drug Reactions
- Tricyclic antidepressants (TCAs) had a 54% higher risk of adverse drug reactions. Other antidepressants had a 61% higher risk compared to SSRIs.
- Selective Risks for Specific Antidepressants
- Trazodone was linked to a significantly increased risk of upper gastrointestinal bleeds.
- Mirtazapine was linked with significantly increased all-cause mortality over both 1-year and 5-year follow-ups.
- Mortality Risks Vary by Antidepressant Class
- TCAs and other antidepressants had higher all-cause mortality rates than SSRIs over 5 years.
- Mirtazapine had consistently higher mortality risks at both 1-year and 5-year follow-ups.
- SSRIs showed reduced mortality rates after 85+ days of treatment.
Summary
The study suggests that SSRIs are linked with an increased risk of fractures. They are also linked to lower overall mortality and fewer adverse drug reactions compared to other antidepressants.
The significantly increased mortality risk linked to mirtazapine raises concerns and warrants further investigation.
4. “Antidepressant Medication Use and Its Association With Cardiovascular Disease and All-Cause Mortality in the REGARDS Study” (Annals of Pharmacotherapy)
This study analyzed data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study.[4]
The aim was to examine the link between second-generation antidepressants and acute coronary heart disease (CHD). These antidepressants include Selective Serotonin Reuptake Inhibitors (SSRIs).
They also included Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), bupropion, nefazodone, and trazodone.
The study also looked at links to stroke, cardiovascular disease (CVD) death, and all-cause mortality. The study followed 29,616 participants from their baseline in-home visit (2003-2007) until December 31, 2011. They tracked medical events every six months.
Key Findings
- Increased Risk of Cardiovascular Events and Mortality in Intermediate Models
- Before adjusting for physical and mental health, antidepressant use was linked with:
- 21% increased risk of acute coronary heart disease (HR = 1.21; 95% CI: 1.04–1.41).
- 28% increased risk of stroke (HR = 1.28; 95% CI: 1.02–1.60).
- 29% increased risk of cardiovascular disease (CVD) death (HR = 1.29; 95% CI: 1.09–1.53).
- 27% increased risk of all-cause mortality (HR = 1.27; 95% CI: 1.15–1.41).
- Before adjusting for physical and mental health, antidepressant use was linked with:
- Fully Adjusted Model Showed Persisting Risk for All-Cause Mortality
- After accounting for other health and lifestyle factors, the link between antidepressant use and heart disease became weaker. The association with stroke also weakened. The connection to heart-related deaths diminished. However, the risk of dying from any cause remained significantly higher for antidepressant users.
Researchers examined data from only the first two years of follow-up. They discovered that antidepressant users had a higher risk of dying from any cause. This was in comparison to those not taking them.
Summary
The study found that antidepressant use was linked with a modest increase in all-cause mortality. This increase was statistically significant, even after full adjustment for potential confounders.
While early models suggested increased risks for cardiovascular events (CHD, stroke, CVD death), these associations weakened after adjustments. Underlying health conditions and lifestyle factors partly explain these risks.
However, the persistent association between antidepressant use and all-cause mortality remains. This highlights the need to investigate these medications’ long-term systemic effects.
5. “Antidepressant Use and Risk of Adverse Outcomes in Older People” (British Medical Journal)
This population-based cohort study investigated the risks linked with antidepressant use in older adults (65+ years) diagnosed with depression. Researchers used data from 570 general practices in the UK QResearch primary care database.[5]
They followed 60,746 patients from 1996 to 2008. The goal was to examine all-cause mortality and various health risks linked to antidepressant treatment. The study analyzed risks by antidepressant class (SSRIs, tricyclics, other antidepressants), dosage, and duration of use.
Key Findings
- Most Older Adults Were Prescribed Antidepressants
- 89% of patients (54,038) received at least one antidepressant prescription.
- A total of 1.4 million antidepressant prescriptions were issued:
- 54.7% were SSRIs
- 31.6% were tricyclic antidepressants
- 13.5% were other antidepressants
- 0.2% were monoamine oxidase inhibitors (MAOIs)
- SSRIs Were Linked to Increased Risks for Falls and Hyponatremia (Low Sodium Levels)
- Patients taking SSRIs had a 66% increased risk of falls (HR = 1.66; 95% CI: 1.58–1.73).
- SSRIs also increased the risk of hyponatremia by 52% (HR = 1.52; 95% CI: 1.33–1.75).
- Mirtazapine and Venlafaxine Were Linked with the Highest Risks for Several Adverse Outcomes
- Compared to non-users, patients on mirtazapine or venlafaxine had the highest risks for:
- All-cause mortality (66% increased risk; HR = 1.66, 95% CI: 1.56–1.77).
- Suicide/self-harm (5.16 times higher risk; HR = 5.16, 95% CI: 3.90–6.83).
- Stroke or transient ischemic attack (37% increased risk; HR = 1.37, 95% CI: 1.22–1.55).
- Fractures (64% increased risk; HR = 1.64, 95% CI: 1.46–1.84).
- Epilepsy/seizures (2.24 times higher risk; HR = 2.24, 95% CI: 1.60–3.15).
- Compared to non-users, patients on mirtazapine or venlafaxine had the highest risks for:
- Certain Antidepressants Had Higher Individual Risks
- Trazodone (tricyclic), mirtazapine, and venlafaxine (other antidepressants) had the highest risk rates for some outcomes.
- Absolute Mortality Risk Over 1 Year
- Patients not on antidepressants: 7.04% mortality rate.
- Tricyclic users: 8.12%.
- SSRI users: 10.61%.
- Mirtazapine or Venlafaxine users: 11.43%.
Summary
SSRIs, mirtazapine, and venlafaxine were linked with a higher risk of several adverse outcomes compared to tricyclic antidepressants.
While SSRIs were mainly linked to falls and hyponatremia, mirtazapine and venlafaxine showed the highest risks for all-cause mortality. These include stroke, fractures, epilepsy, and suicide/self-harm.
The findings suggest that certain antidepressants, especially trazodone, mirtazapine, and venlafaxine, pose higher risks in older adults.
Conclusion: The Link Between Antidepressants and Chronic Disease
The findings from these five large-scale cohort studies highlight significant long-term health risks linked with antidepressant use. These risks relate particularly to cardiovascular disease, fractures, falls, adverse drug reactions, and all-cause mortality.
Antidepressants are widely prescribed for depression. This is especially true for Selective Serotonin Reuptake Inhibitors (SSRIs). They offer benefits like lower risks of diabetes and hypertension. However, studies consistently found increased risks of serious adverse outcomes. These risks are exceptionally prominent with long-term use.
- Cardiovascular and Mortality Risks
- Multiple studies found that long-term antidepressant use was linked to higher risks of cardiovascular disease (CVD). It also increases the risk of stroke and heart disease (Studies 1, 2, and 4).
- · All-cause mortality was consistently higher in antidepressant users. Some studies reported a 66%-120% increased risk compared to non-users. (Studies 1, 4, and 5).
- Risks in Younger and Middle-Aged Adults
- Study 3 (BMC Medicine) found that people aged 20-64 who took antidepressants had significantly higher risks of fractures and falls. They also had increased risks of upper gastrointestinal bleeds and road traffic accidents. Additionally, they faced adverse drug reactions.
- Mirtazapine, in particular, was linked to increased mortality rates in both short- and long-term follow-ups.
- Risks in Older Adults
- Study 5 (BMJ) showed that SSRIs and other antidepressants posed serious risks in older adults. These risks included falls, fractures, epilepsy, and hyponatremia (low sodium levels). As a result, the risk of hospitalizations and complications increases.
- Trazodone, mirtazapine, and venlafaxine were among the highest-risk drugs for mortality and adverse effects in elderly patients.
- Lack of Cardiovascular Protection From SSRIs
- While SSRIs are often perceived as safer than older antidepressants like tricyclics, they may not be. Study 2 (JAMA Heart Association) found no significant difference in cardiovascular risk. This was observed between SSRI users and non-SSRI users
- This contradicts the assumption that SSRIs are a safer choice for heart health.
- Balancing Benefits and Risks: While antidepressants can be essential for managing depression, there is increasing evidence of their long-term risks. This evidence calls for the careful evaluation of prescribing practices.
Doctors need to consider other treatments. These include lifestyle interventions, therapy, and other non-pharmacological approaches. This is especially important for individuals at high risk of cardiovascular disease, falls, or other adverse events.
Overall Conclusion: The Impact of Expanding Antidepressant Use on Public Health
The increased use of antidepressants over the past few decades has been driven by multiple factors. These include changes in the definition of depression. Societal shifts contribute as well. There is also aggressive direct-to-consumer (DTC) pharmaceutical advertising.
The broadening of diagnostic criteria in the DSM has led to a greater number of people qualifying for treatment. The bereavement exclusion was removed. There was also the inclusion of new depressive disorders.
At the same time, social stressors, as well as economic pressures, have contributed. Changing family dynamics have also contributed to higher rates of diagnosed depression. These factors have led to an increased reliance on medication.
Furthermore, DTC advertising, particularly in the United States, has normalized the long-term use of antidepressants. This reinforces the idea that depression is a lifelong condition. It suggests that continuous pharmacological management is necessary.
As a result, antidepressant prescriptions have surged, leading to massive financial gains for the pharmaceutical industry. Studies show that antidepressant sales have skyrocketed post-DSM-5, generating billions of dollars annually for drug manufacturers. While these medications have provided relief for many, the long-term consequences of widespread antidepressant use have become increasingly evident.
Findings from multiple large-scale studies show that long-term antidepressant use is linked with increased risks. These include cardiovascular disease, fractures, falls, adverse drug reactions, and all-cause mortality.
SSRIs and other second-generation antidepressants were once believed to be safer than older medications like tricyclic antidepressants. However, research has challenged this assumption. It shows that these drugs do not offer cardiovascular protection. Research shows that they contribute to a range of health complications.
Moreover, the DSM is an American classification system, but its influence extends worldwide. It shapes clinical guidelines, research, and prescribing patterns in many countries.
As a result, changes made in the DSM-5 have not only increased antidepressant use in the U.S. but have also contributed to rising prescription rates globally.
Countries that follow DSM-based diagnostic frameworks have seen similar trends. Their expanding antidepressant use further amplifies the long-term health consequences at a global level.
Ultimately, the expansion of antidepressant prescriptions has not necessarily led to improved long-term health outcomes for the population. Instead, the widespread and prolonged use of these drugs has contributed to significant health risks, including increased mortality rates.
This raises concerns about the medicalization of normal emotional distress. There is also worry about the over-reliance on pharmaceutical solutions.
There is a need for a more balanced approach to treating depression. Such an approach should focus on holistic care, lifestyle interventions, and individualized treatment plans over defaulting to long-term medication use.
Lithium is an inexpensive antidepressant. Interestingly, lithium was not included in the studies. I think I know why. In contrast to the other antidepressants, lithium lowers all-cause mortality. Read more about it at:
Stunning Low Doses Of Lithium Really Improve Survival
Future articles will show the effects of fasting and exercise on depression.
Important Disclaimer: Do Not Stop Your Antidepressants Abruptly!
This article highlights the potential long-term health risks of antidepressants.
You must consult your healthcare provider before stopping your medication suddenly. Stopping antidepressants abruptly can lead to serious withdrawal symptoms, worsening depression, and other health complications.
If you are concerned about the effects of antidepressants on your long-term health, talk to your doctor. Discuss your treatment options with your healthcare provider.
Speak with your doctor or healthcare provider about your treatment options. If necessary, they can help you explore safer alternatives, dosage adjustments, or gradual tapering strategies. Your mental health matters, and making informed decisions under medical supervision is the safest approach.
Always consult a medical professional before making any changes to your medication. Your well-being is the top priority!
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Related:
- Serotonin levels do not correlate with depression
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- Stunning Low Doses Of Lithium Really Improve Survival
References:
- Bansal N, Hudda M, Payne RA, Smith DJ, Kessler D, Wiles N. Antidepressant use and risk of adverse outcomes: population-based cohort study. BJPsych Open. 2022 Sep 13;8(5):e164. doi: 10.1192/bjo.2022.563. PMID: 36097725; PMCID: PMC9534882.
- Almuwaqqat Z, Jokhadar M, Norby FL, Lutsey PL, O’Neal WT, Seyerle A, Soliman EZ, Chen LY, Bremner JD, Vaccarino V, Shah AJ, Alonso A. Association of Antidepressant Medication Type With the Incidence of Cardiovascular Disease in the ARIC Study. J Am Heart Assoc. 2019 Jun 4;8(11):e012503. doi: 10.1161/JAHA.119.012503. Epub 2019 May 29. PMID: 31140335; PMCID: PMC6585369.
- Coupland C, Hill T, Morriss R, Moore M, Arthur A, Hippisley-Cox J. Antidepressant use and risk of adverse outcomes in people aged 20-64 years: cohort study using a primary care database. BMC Med. 2018 Mar 8;16(1):36. doi: 10.1186/s12916-018-1022-x. PMID: 29514662; PMCID: PMC5842559.
- Hansen RA, Khodneva Y, Glasser SP, Qian J, Redmond N, Safford MM. Antidepressant Medication Use and Its Association With Cardiovascular Disease and All-Cause Mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Ann Pharmacother. 2016 Apr;50(4):253-61. doi: 10.1177/1060028015625284. Epub 2016 Jan 18. PMID: 26783360; PMCID: PMC5822680.
- Coupland C, Dhiman P, Morriss R, Arthur A, Barton G, Hippisley-Cox J. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ. 2011 Aug 2;343:d4551. doi: 10.1136/bmj.d4551. PMID: 21810886; PMCID: PMC3149102
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