Umbrella Review: Antidepressant Use Appears Safe

Antidepressant use appears to be safe, according to a systematic umbrella review of 45 meta-analyses spanning more than 1000 observational studies. Researchers published findings from their review online in JAMA Psychiatry.

“As far as we know, this is the first study to assess the safety and adverse health outcomes associated with antidepressant use on such a large scale considering real-world data,” said lead author Elena Dragioti, PhD, of Linköping University in Sweden and the University of Ioannina in Greece. “However, it is important to note that our study did not evaluate the efficacy of the drugs.”

Researchers conducted the review to gauge the credibility of evidence linking antidepressant use with adverse health outcomes. While they initially found convincing evidence of a link between antidepressant use and suicide attempt and completion in patients younger than 19, as well as between antidepressant use and autism risk in offspring, those associations were not convincing after researchers adjusted for confounding by psychiatric indication.

“We found that all of the adverse health outcomes reported in observational studies that were supported by strong evidence were actually probably due to the underlying psychiatric conditions for which antidepressants had been prescribed, rather than the antidepressants themselves,” explained Marco Solmi, MD, PhD, of the University of Padua in Italy and King's College London in the United Kingdom. “Most of these studies also suffered from several biases, such as a lack of randomization.”

The review concluded that most of the reputed adverse health outcomes associated with antidepressants appear not to be supported by convincing evidence. Furthermore, no absolute contradictions to antidepressants were found.

“Even though we have shown that antidepressants are generally safe, we should note that adverse effects must be monitored clinically during antidepressant treatment,” cautioned senior author Evangelos Evangelou, PhD, of the University of Ioannina in Greece and Imperial College in London. “Further, we have only limited evidence from randomized clinical trials about long-term adverse health outcomes. Moreover, we were not able to assess several newer antidepressants due to limited available data.”

—Jolynn Tumolo

References

Dragioti E, Solmi M, Favaro A, et al. Association of antidepressant use with adverse health outcomes: a systematic umbrella review. JAMA Psychiatry. 2019 October 2;[Epub ahead of print].

Söderlund Leifler K. Antidepressant medications appear to be generally safe [press release]. Linköping, Sweden: Linköping University; October 2, 2019.