Dangers of Antidepressant Use Not Supported by Evidence

The findings of a new study suggest adverse health outcomes linked to antidepressant may not be supported by strong evidence.

Elena Dragioti, PhD, Linköping University, led a systematic umbrella review of 45 meta-analyses of observational studies and did not find associations at convincing levels between both antidepressant use and suicide attempt or completion among individuals younger than 19 years old and between antidepressant use and autism risk among offspring.

With increasing rates of depression and other mental health disorders, antidepressant use is increasing globally.

While 8-10% of adults in the US take at least 1 antidepressant drug, there contrasting evidence on the safety of the medications is available from meta-analyses and the credibility of the findings has not been previously quantified.

“This study’s findings suggest that most putative adverse health outcomes associated with antidepressant use may not be supported by convincing evidence, and confounding by indication may alter the few associations with convincing evidence,” the authors wrote. “Antidepressant use appears to be safe for the treatment of psychiatric disorders, but more studies matching for underlying disease are needed to clarify the degree of confounding by indication and other biases.”

The search included observational studies of the association between any adverse health outcome and exposure to antidepressants, including adverse health outcomes such as harms, suicide, bleeding, and autism.

Included in the study are meta-analyses of observation studies with a cohort or case-control study design. The data derived from the studies were recorded and assessed for methodological quality by a pair of independent reviewers.

Among the 120 associations, only 3 were supported by convincing evidence, particularly the link between selective serotonin reuptake inhibitor (SSRI) use and the increased risk of suicide attempt or completion in children and adolescents.

They also discovered the association between the exposure to any antidepressant before pregnancy and SSRIs during pregnancy and autism spectrum disorder.

However, there were 21 additional associations between antidepressant use and adverse health outcomes, but the remaining associations featured either weak evidence (n=39) or no evidence (n=46).

They also found 11 associations with highly suggestive evidence of the association between any antidepressant use and increased risk of adverse health outcomes, including attention-deficit/hyperactivity disorder in children, cataract development associated with tricyclic antidepressants (TCAs), severe bleeding at any site, and upper gastrointestinal tract bleeding.

Other links included increased risks for postpartum hemorrhage, preterm birth, lower Apgar score at 5 minutes, osteoporotic fractures linked to both TCAs and SSRIs, and the risk of hip fracture.

“Convincing evidence emerged from both main and sensitivity analyses for the association between antidepressant use and risk of suicide attempt or completion among children and adolescents, autism spectrum disorders with antidepressant exposure before and during pregnancy, preterm birth, and low Apgar scores,” the authors wrote. “None of these associations remained supported by convincing evidence after sensitivity analysis, which adjusted for confounding by indication.”

The study, “Association of Antidepressant Use With Adverse Health Outcomes,” was published online in JAMA Psychiatry.