Use of venlafaxine compared with other antidepressants and the risk of sudden cardiac death or near death: a nested case-control study.
OBJECTIVE
To assess whether use of the antidepressant venlafaxine is associated with an increased risk of sudden cardiac death or near death compared with other commonly used antidepressants.


METHODS
Population based observational study.


METHODS
We did a nested case-control analysis within a new user cohort formed using the United Kingdom General Practice Research Database.


METHODS
New users of venlafaxine, fluoxetine, citalopram, or dosulepin on or after 1 January 1995, aged 18 to 89 years, with a diagnosis of depression or anxiety. Participants were followed-up until February 2005, or the occurrence of sudden cardiac death or near death, identified from medical records indicating non-fatal acute ventricular tachyarrhythmia, sudden death due to cardiac causes, or out of hospital deaths from acute ischaemic cardiac events. For each case, 30 controls were selected matched for age, sex, calendar time, and indication. We used conditional logistic regression to calculate the adjusted odds ratio of sudden cardiac death or near death associated with current use of venlafaxine compared with current use of fluoxetine, citalopram or dosulepin.


RESULTS
207 384 participants were followed-up for an average of 3.3 years. There were 568 cases of sudden cardiac death or near death, which were matched to 14 812 controls. The adjusted odds ratio of sudden cardiac death or near death associated with venlafaxine use was 0.66 (95% confidence interval 0.38 to 1.14) relative to fluoxetine use, whereas compared with citalopram it was 0.89 (0.50 to 1.60) and with dosulepin 0.83 (0.46 to 1.52).


CONCLUSIONS
In this large, population based study, the use of venlafaxine was not associated with an excess risk of sudden cardiac death or near death compared with fluoxetine, dosulepin, or citalopram, in patients with depression or anxiety.
Centre for Clinical Epidemiology, Jewish General Hospital, and Department of Epidemiology, McGill University, Montreal, Canada.
Carlos
C
Martinez
Themistocles L
TL
Assimes
Daniel
D
Mines
Sophie
S
Dell'aniello
Samy
S
Suissa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects*; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects; D016022:Case-Control Studies; D003511:Cyclohexanols / Q000009:adverse effects*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D003866:Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D000069470:Venlafaxine Hydrochloride; D055815:Young Adult
D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride