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Cited by 215Treatment of Major DepressionPharmacovigilance and Adverse Drug ReactionsMaternal Mental Health During Pregnancy and Postpartum

Association of Antidepressant Use With Adverse Health Outcomes: A Systematic Umbrella Review

Open access
Dragioti, Elena, Solmi, Marco, Favaro, Angela, Fusar-Poli, Paolo, Dazzan, Paola, Thompson, Trevor, Stubbs, Brendon, Firth, Joseph +9 more·2019·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2019.2859PMC PMC6777224
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Abstract

Importance: Antidepressant use is increasing worldwide. Yet, contrasting evidence on the safety of antidepressants is available from meta-analyses, and the credibility of these findings has not been quantified. Objective: To grade the evidence from published meta-analyses of observational studies that assessed the association between antidepressant use or exposure and adverse health outcomes. Data Sources: PubMed, Scopus, and PsycINFO were searched from database inception to April 5, 2019. Evidence Review: Only meta-analyses of observational studies with a cohort or case-control study design were eligible. Two independent reviewers recorded the data and assessed the methodological quality of the included meta-analyses. Evidence of association was ranked according to established criteria as follows: convincing, highly suggestive, suggestive, weak, or not significant. Results: Forty-five meta-analyses (17.9%) from 4471 studies identified and 252 full-text articles scrutinized were selected that described 120 associations, including data from 1012 individual effect size estimates. Seventy-four (61.7%) of the 120 associations were nominally statistically significant at P ≤ .05 using random-effects models. Fifty-two associations (43.4%) had large heterogeneity (I2 > 50%), whereas small-study effects were found for 17 associations (14.2%) and excess significance bias was found for 9 associations (7.5%). 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. None of these associations remained supported by convincing evidence after sensitivity analysis, which adjusted for confounding by indication. Conclusions and Relevance: 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. 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. No absolute contraindication to antidepressants emerged from this umbrella review.

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  • Findingown data

    In sensitivity analyses restricted to cohort studies, prospective cohort studies, studies adjusted for confounding by indication, and North American studies, no convincing-evidence association kept its rank.

    “A sensitivity analysis limited to cohort studies, prospective cohort studies, studies controlled for confounding by indication, and North American studies showed that none of the associations within convincing evidence (class I) retained the same rank (Table 3).”
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  • Findingown data

    Autism remained rare, with pooled cohort-study prevalence below 1%.

    “However, autism remains a rare event, with a prevalence from cohort studies of less than 1% according to data pooled in this study.”
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  • Findingown data

    For 63 associations (52.5%), the largest study's effect size was nominally significant at P ≤ .05.

    “In 63 associations (52.5%), the effect sizes of the largest study were nominally statistically significant at P ≤ .05.”
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  • Findingown data

    None of the associations with convincing evidence remained at that level after accounting for confounding by indication.

    “However, the few with convincing evidence associations did not reflect causality, and none of them remained at the convincing evidence level after accounting for confounding by indication.”
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  • Findingown data

    The 45 eligible meta-analyses reported 120 associations and 1012 individual estimates of adverse outcomes linked to antidepressant exposure.

    “Forty-five eligible meta-analyses described 120 associations, including 1012 individual study estimates of adverse health outcomes associated with exposure to antidepressants (Table 2 and eTables 2-5 in the Supplement), with a median (IQR) number of estimates per association of 6 (4-12).”
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    Findingcitation

    Nearly all significant associations showed higher risk with antidepressants; two exceptions showed SSRIs protecting against suicide attempt or completion in adults and older adults.

    “Almost all statistically significant associations indicated an increased risk for antidepressants and adverse health outcomes except for 2 associations (2.7%) showing the protective property of SSRIs against suicide attempt or completion in adults and in older adults.80”
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    Findingcitation

    Three of 120 associations (2.5%) had convincing evidence: SSRI use with increased suicide attempt or completion in children and adolescents, and any antidepressant before pregnancy or SSRIs during pregnancy with autism spectrum disorder.

    “Among the 120 associations, 3 (2.5%) were supported by convincing evidence, namely, the association between SSRI use and increased risk of suicide attempt or completion in children and adolescents 80 as well as the association between exposure to any antidepressant before pregnancy and SSRIs during pregnancy and autism spectrum disorder 51,52 (Table 2).”
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    Findingown data

    For outcomes with convincing or highly suggestive evidence, effect sizes were small and prevalence was generally low, ranging from 0.1% to 9.7%.

    “The effect sizes of those adverse outcomes supported by convincing and highly suggestive evidence were small and the prevalence was on average low (range, 0.1%-9.7%)as well (Tables 2 and 3).”
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    Findingown data

    The remaining associations had weak evidence for 39 (32.5%) and no evidence for 46 (38.3%).

    “For the remaining associations, either weak evidence (n = 39 [32.5%]) or no evidence (n = 46 [38.3%] was found (ie, all associations with P > .05) (eTables 4 and 5 in the Supplement).”
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    Findingown data

    The highly suggestive outcomes were ADHD in children, cataract development with TCAs, severe bleeding at any site, upper gastrointestinal bleeding, postpartum hemorrhage, preterm birth, lower 5-minute Apgar score, osteoporotic fractures (one with TCAs and one with SSRIs), and hip fracture risk.

    “The adverse outcomes were attention-deficit/hyperactivity disorder in children, cataract development (associated with TCAs), severe bleeding at any site, upper gastrointestinal tract bleeding, postpartum hemorrhage, preterm birth, lower Apgar score at 5 minutes, osteoporotic fractures (1 associated with TCAs and 1 with SSRIs), and risk of hip fracture.”
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    Findingown data

    The umbrella review ultimately included 45 meta-analyses of observational studies, which together covered 695 studies, 1012 study estimates, and 13 putative risks.

    “we identified 4471 studies, scrutinized 252 full-text articles, and ultimately included 45 meta-analyses (17.9%) in this umbrella review (Figure 1), corresponding to 695 studies, 1012 study estimates, and 13 putative risks (Figure 2).”
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    Findingown data

    The review found that only a few of the 74 significant associations were supported by convincing evidence in main and sensitivity analyses: elevated risk of suicide attempt or completion in those under 19 years (SSRI studies), autism risk in offspring, preterm birth, and neonatal adaptation.

    “We reviewed 45 meta-analyses of observational studies and found that only a few of the 74 statistically significant associations between antidepressants and adverse health outcomes were supported by convincing evidence in the main and sensitivity analyses, namely, the association between antidepressant use and increased suicide attempt or completion in individuals younger than 19 years (SSRI studi”
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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects risk ratio for ADHD in children with SSRI/non-SSRI use was 1.67 (95% CI, 1.53-1.82), based on 22 studies, with class II/Moderate evidence.

    “RR: 1.67 | (1.53 to 1.82)”
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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects risk ratio for preterm birth with any antidepressant use versus no antidepressant use was 1.67 (95% CI, 1.51-1.86), based on 24 studies, with class II/Moderate evidence.

    “RR: 1.67 | (1.51 to 1.86)”
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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects standardized mean difference for Apgar score at 5 minutes with any antidepressant use versus no antidepressant use was -0.33 (95% CI, -0.47 to -0.20), based on 15 studies, with class II/Moderate evidence.

    “SMD: -0.33 | (-0.47 to -0.20)”
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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects odds ratio for autism spectrum disorders with maternal SSRI exposure (unadjusted estimates) was 1.65 (95% CI, 1.37-2.00), based on 3 studies, with class II/Moderate evidence.

    “OR: 1.65 | (1.37 to 2.00)”
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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects risk ratio for osteoporotic fractures with TCA use versus non-TCA use was 1.48 (95% CI, 1.32-1.67), based on 15 studies, with class II/Moderate evidence.

    “RR: 1.48 | (1.32 to 1.67)”
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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects odds ratio for suicide attempt and completion in adults with SSRI/non-SSRI use was 0.53 (95% CI, 0.43-0.66), based on 5 studies, with class II/High evidence.

    “OR: 0.53 | (0.43 to 0.66)”
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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects odds ratio for osteoporotic fractures with SSRI/non-SSRI use, adjusted for multiple covariates, was 1.92 (95% CI, 1.51-2.44), based on 5 studies, with class I/High evidence.

    “OR: 1.92 | (1.51 to 2.44)”
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    • cites Khanassov et al, 42 2018 source

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    In a sensitivity analysis of class I or II evidence, the random-effects risk ratio for autism spectrum disorders with prepregnancy maternal antidepressant exposure versus no antidepressant use was 1.87 (95% CI, 1.52-2.30), based on 11 studies, with class I/Moderate evidence.

    “RR: 1.87 | (1.52 to 2.30)”
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    In a sensitivity analysis of class I or II evidence, the random-effects risk ratio for hip fracture with TCA and/or SSRI use versus no antidepressant use was 1.43 (95% CI, 1.29-1.58), based on 11 studies, with class II/Moderate evidence.

    “RR: 1.43 | (1.29 to 1.58)”
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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects risk ratio for suicide attempt and completion in children and adolescents with any antidepressant use versus no antidepressant use, adjusted for multiple covariates, was 1.48 (95% CI, 1.29-1.71), based on 7 studies, with class I/Moderate evidence.

    “RR: 1.48 | (1.29 to 1.71)”
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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects risk ratio for upper GI bleeding with SSRI plus other non-antidepressant use versus no SSRI use was 1.39 (95% CI, 1.21-1.61), based on 7 studies, with class II/Moderate evidence.

    “RR: 1.39 | (1.21 to 1.61)”
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    • cites Jiang et al, 64 2015 source

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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects risk ratio for osteoporotic fractures with SSRI/non-SSRI use was 1.63 (95% CI, 1.49-1.79), based on 16 studies, with class II/Moderate evidence.

    “RR: 1.63 | (1.49 to 1.79)”
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    • cites Khanassov et al, 42 2018 source

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    Findingcitation

    In a sensitivity analysis of class I or II evidence, the random-effects odds ratio for suicide attempt and completion in children and adolescents with SSRI/non-SSRI use was 1.89 (95% CI, 1.46-2.43), based on 3 studies, with class II/High evidence.

    “OR: 1.89 | (1.46 to 2.43)”
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    Study design and conductcitation

    The grading system can only warn about potential systematic biases and cannot establish their nature or extent.

    “Fifth, we used a grading system that can provide only warnings of the potential presence of systematic biases but cannot provide evidence of the nature and extent of these biases, 16,32,33 just as umbrella reviews cannot supply any comparative ranking as in network meta-analyses.”
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    Interpretationcitation

    The convincing evidence for autism and youth suicidality was not confirmed after considering confounding by indication, suggesting these associations may stem from the underlying disease rather than antidepressant use.

    “The convincing evidence level was not confirmed when confounding by indication was considered, suggesting that the association between antidepressant use and autism as well as suicidality in youth and other outcomes may be due to the underlying disease rather than to the use of antidepressants, 39,43,44,50 as shown in a recent umbrella review on risk factors for autism.86”
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    Interpretationreasoning

    Several adverse outcomes had small effect sizes, low prevalence, and no proof of a causal link with antidepressants.

    “Several adverse outcomes had small effect sizes in addition to low prevalence and no proof of a causal relationship between antidepressants and adverse health outcomes.”
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    Premisecitation

    Increased fracture risk applied mainly to older people over 65 with poor bone status and multimorbidity, not to those aged 20 to 40.

    “For instance, increased risk of fractures applied predominantly to an older population (>65 years) already prone to poor bone status and multimorbidity 84 and not to people aged 20 to 40 years.”
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    Premisecitation

    Meta-analyses support antidepressant efficacy for anxiety disorders and OCD in adults.

    “Similarly, meta-analyses support the efficacy of antidepressant use for anxiety disorders 5 and obsessive-compulsive disorder 3 in adults.”
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    Premisecitation

    In children and adolescents, a network meta-analysis of randomized trials found no antidepressant superior to placebo except fluoxetine, higher discontinuation for several antidepressants, and increased suicidality with venlafaxine even in short-term trials.

    “A network metaanalysis of RCTs in children and adolescents showed that no antidepressant medication was superior to placebo apart from fluoxetine, that several antidepressants had higher discontinuation rates compared with placebo, and that venlafaxine increased the risk of suicidality even in the short-term duration of an RCT. 13”
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    Premisecitation

    Antidepressants are indicated for depressive disorders, anxiety disorders, PTSD, premenstrual dysphoric disorder, OCD, bulimia nervosa, and binge-eating disorder.

    “Antidepressants are indicated and used for depressive disorders, anxiety disorders, posttraumatic stress disorder, premenstrual dysphoric disorder, obsessive-compulsive disorder, bulimia nervosa, and binge-eating disorder, among others.[3][4][5]”
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    Premisecitation

    Roughly one in ten US adults, or 8% to 10%, use an antidepressant.

    “Up to 8% to 10% of adults in the United States take at least 1 antidepressant drug, which is ranked third among prescribed and fourth among sold medications.1,2”
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    Premisecitation

    RCT safety assessment is biased by unrepresentative small samples, inconsistent and rare reporting of harms, and short exposure periods.

    “but safety assessment is inherently biased by certain methodological weaknesses of RCTs.These weaknesses include small and unrepresentative samples, rare and inconsistent reporting of adverse outcomes, and short duration of exposures.14,15”
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    Premisereasoning

    The safety profile of antidepressants is controversial.

    “The safety profile of antidepressants is controversial.”
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  • The paper relies on this without support.

    No prior attempt had been made to quantify the credibility of findings from meta-analyses on antidepressant safety.

    “Several meta-analyses of observational studies have been published that assess antidepressant safety; however, to our knowledge, no attempt has been made to quantify the credibility of their findings.”
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References 105 · Cited by 215

Research works printed but not linked: 8

  1. Pratt, 2011, Antidepressant use in persons aged 12 and over: United States, 2005-2008., NCHS Data Brief, 1
  2. Gibbons, 2012, Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine., Arch Gen Psychiatry, 69, 580, 10.1001/archgenpsychiatry.2011.2048 · DOI · Paper page
  3. Bridge, 2007, Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials., JAMA, 297, 1683, 10.1001/jama.297.15.1683 · DOI · Paper page
  4. Stroup, 2000, Meta-analysis of Observational Studies in Epidemiology: a proposal for reporting., JAMA, 283, 2008, 10.1001/jama.283.15.2008 · DOI · Paper page
  5. Ross, 2013, Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis., JAMA Psychiatry, 70, 436, 10.1001/jamapsychiatry.2013.684 · DOI · Paper page
  6. Grigoriadis, 2013, The effect of prenatal antidepressant exposure on neonatal adaptation: a systematic review and meta-analysis., J Clin Psychiatry, 74, e309, 10.4088/JCP.12r07967 · DOI
  7. Lee, 2012, Meta-analysis: selective serotonin reuptake inhibitors and colon cancer., Eur J Gastroenterol Hepatol, 24, 1153, 10.1097/MEG.0b013e328355e289 · DOI
  8. British Medical Association, 2009, British National Formulary 57

Authors
Dragioti, E., Solmi, M., Favaro, A., Fusar-Poli, P., Dazzan, P., Thompson, T., Stubbs, B., Firth, J., Fornaro, M., Tsartsalis, D., Carvalho, A. F., Vieta, E., McGuire, P., Young, A. H., Shin, J. I., Correll, C. U., & Evangelou, E.
Affiliations
  • Linköping University (SE)
  • University of Padua (IT)
  • Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
  • King's College London (GB)
  • University of Greenwich (GB)
  • National Health Service (GB)
  • The University of Melbourne (AU)
  • University of Naples Federico II (IT)
  • Centre for Addiction and Mental Health (CA)
  • Centro de Investigación Biomédica en Red de Salud Mental (ES)
  • Yonsei University (KR)
  • Feinstein Institute for Medical Research (US)
  • Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, Ioannina, Greece
Corresponding author
Dragioti, Elena
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2019-12-01
Volume
76
Issue
12
Pages
1241
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2019.2859
PMC
PMC6777224
OpenAlex
W2977696925
Cited by
215
References
105
Citations by year
2026: 25 · 2025: 19 · 2024: 31 · 2023: 26 · 2022: 45 · 2021: 35 · 2020: 28 · 2019: 4 · 2018: 1 · 2017: 1
FWCI
3.60
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, other-oa)
  • Greenwich Academic Literature Archive (University of Greenwich) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • Spiral (Imperial College London) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Funders
  • Bristol-Myers Squibb
  • Pfizer
  • Teva Pharmaceutical Industries
  • South London and Maudsley NHS Foundation Trust
  • Sunovion
  • Indivior
  • Maudsley Charity
  • Northwell Health
  • Michael Smith Health Research BC
  • National Institute for Health and Care Research (NF-SI-0616-10091, ICA-CL-2017-03-001, NIHR-INF-0685)
  • Imperial College London
  • King's College London
  • Yonsei University
  • Gedeon Richter
  • University of Toronto
  • Linköpings Universitet
  • Ministerio de Ciencia e Innovación
  • Universitat de Barcelona
  • Centro de Investigación Biomédica en Red de Salud Mental
  • Servier
  • H. Lundbeck A/S
  • Berlin Institute of Health
  • Allergan
  • Department of Psychiatry, University of Toronto
  • Western Economic Diversification Canada
  • Yonsei University College of Medicine
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
antidepressants, antidepressant safety, adverse health effects, level of evidence, confounding by indication, heterogeneity, small-study effects, autism spectrum disorder, prenatal antidepressant exposure, preterm birth, Apgar score, sensitivity analysis
MeSH terms
Autism Spectrum Disorder, Suicide, Completed, Adolescent, Antidepressive Agents, Apgar Score, Mental Disorders, Child, Female, Humans, Pregnancy, Prenatal Exposure Delayed Effects, Suicide, Attempted, Meta-Analysis as Topic, Premature Birth, Observational Studies as Topic

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