title: Use of antidepressants and the risk of cardiovascular and cerebrovascular disease: a meta-analysis of observational studies.
abstract: OBJECTIVE
  This study aims to systematically review studies quantifying the associations between antidepressants (ADs) use and the risk of cardiovascular (CV) outcomes.
  
  
  METHODS
  Medline was searched to October 2015 for full text articles in English. Prospective cohort and case-control studies were admitted if they investigated the relationship between current use of ADs as a whole, tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs), and the onset CV events. Summary relative risks (RRs) with confidence intervals (CIs) were calculated using random-effects or fixed-effects models.
  
  
  RESULTS
  A total of 99,367 incident cases of CV outcomes who met inclusion criteria were identified from 22 observational studies. Compared with no users of ADs, use of SSRIs was associated with an increased risk of cerebrovascular disease (RRs, 1.24; 95% CI, 1.15 to 1.34), while the use of TCA was associated with an increased risk of acute heart disease (RRs, 1.29; 95% CI, 1.09 to 1.54).
  
  
  CONCLUSIONS
  The results of this meta-analysis have to be taken with caution because even though an increased risk of cerebrovascular and acute heart disease was observed respectively in SSRIs and TCA users, the estimates are characterized by a high between study heterogeneity. Moreover, it was not possible to distinguish between the effects of ADs and depression itself. Further well-designed studies are required to confirm this association.
authors.affiliation: Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy. a.biffi14@campus.unimib.it.
authors.forename: A
authors.initials: A
authors.lastname: Biffi
authors.affiliation: Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Scotti
authors.affiliation: Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Corrao
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D006801:Humans; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressants; Cardiovascular disease; Cerebrovascular disease; Depression; Selective serotonin reuptake inhibitors; Stroke; Tricyclic antidepressants