title: Impact of antidepressants use on risk of myocardial infarction: A systematic review and meta-analysis.
abstract: OBJECTIVE
  The aim of the study was to perform a systematic review and meta-analysis to determine the association between antidepressants use and risk of myocardial infarction (MI), and whether this association differs between tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).
  
  
  METHODS
  A PubMed/MEDLINE search was conducted for studies published up to December 2013. Included studies were evaluated for publication bias and heterogeneity. Depending on the presence of heterogeneity, a random or fixed effects model was used to identify the pooled relative risk (RR) with 95% confidence intervals (CIs). Cumulative meta-analysis, subgroup and sensitivity analyses were also performed. All analyses were performed using comprehensive meta-analysis software.
  
  
  RESULTS
  Fourteen (five cohort and nine case-control) studies were included. There was heterogeneity among the studies (P heterogeneity = 0.02; I (2) = 68%) but no publication bias (Begg's P = 0.30 and Egger's P = 0.45). Antidepressants use significantly increases the risk of myocardial infarction (MI) (RR = 2.03; 95% CI = 1.30-3.18; P < 0.01). On subgroup analysis by study design, cohort studies show significant positive association (RR = 2.16; 95% CI = 1.42-3.29; P < 0.01), but not case-control studies (RR = 2.47; 95% CI = 0.69-8.90; P = 0.17). Sensitivity analysis and cumulative meta-analysis confirmed the stability of results. TCAs users are having 36% increased risk of MI after excluding one outlier (RR = 1.36; 95% CI = 1.10-1.67; P < 0.01), but SSRIs showing no association (RR = 0.84; 95% CI = 0.57-1.22; P = 0.35).
  
  
  CONCLUSIONS
  We found evidence that the use of antidepressants was associated with elevated risk of MI. Further research is needed to identify the underlying biological mechanisms.
authors.affiliation: Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka, India.
authors.forename: Krishna
authors.initials: K
authors.lastname: Undela
authors.affiliation: Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka, India.
authors.forename: Gurumurthy
authors.initials: G
authors.lastname: Parthasarathi
authors.affiliation: Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka, India.
authors.forename: Sharon Sunny
authors.initials: SS
authors.lastname: John
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D006801:Humans; D009203:Myocardial Infarction / Q000139:chemically induced*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Myocardial infarction; selective serotonin reuptake inhibitors; tricyclic antidepressants