Antidepressant risks

The MHRA warns that antidepressants are associated with increased risks of pulmonary hypertension in neonates and fractures (Drug Safety Update 2010;3:Issue 10).

    Exposure to SSRIs after the 20th week of pregnancy is associated with a significantly increased risk of persistent pulmonary hypertension in neonates, epidemiological studies have shown. Estimates of the excess risk range from 2.4 to 6.1, raising the incidence from 1-2 per 1000 to 5 per 1000. A similar risk with SNRIs such as venlafaxine and duloxetine (Cymbalta) cannot be excluded, the MHRA says.
    SSRIs and TCAs may slightly increase the risk of fractures in the over-50s. Observational data suggest the risk peaks within one to two months of starting treatment with a TCA and disappears after 6-12 months. With SSRIs, the risk peaks within 6-12 months then plateaus. The risk diminishes 3-12 months after stopping treatment for both SSRIs and TCAs.
    The MHRA also warns that treatment with simva­statin 80mg daily should be limited to patients with severe hypercholesterol­aemia at high risk of cardiovascular events who cannot achieve target lipid levels on a lower dose, when the expected benefit outweighs the risk of myopathy.
• The risk of suicide is similar for all types of antidepressants, a large observational study from Canada suggests (Arch Gen Psychiatry 2010;67:497-506).
    The analysis of healthcare data for 287 543 adults with depression found no differences within the SSRIs or with TCAs, SNRIs or atypical antidepressants. The combined rate of fatal suicide and admission for self-harm ranged from 4.4 to 9.1 per 1000 person-years of treatment; most events occurred during the first six months of treatment.