Abstract
BACKGROUND: Patients with psychiatric disorders have an increased all-cause mortality as well as an increased risk for sudden cardiac death (SCD) across all age groups. We have previously shown that patients with depressive disorders had a 2-fold increased risk of SCD compared to the general population. However, the impact of antidepressants (AD) exposure on SCD risk is unclear. PURPOSE: To investigate the association between length of antidepressant use and SCD in patients aged 18-90 years in the Danish population in one year. METHODS: We examined all deaths in Denmark among residents aged 18-90 years in 2010 by reviewing all death certificates and autopsy reports. Deaths were categorized as non-SCD or SCD based on the available information. Exposure to AD was defined by redemption of a prescription for AD-medication at least 2 times in one year over a period of 12 years before the year of follow-up (2010). Furthermore, exposure time was categorized into two groups: 1-5 years and 6+ years. RESULTS: Of 4.3 million residents in 2010 aged 18-90 years, there was a total of 45 701 deaths and 6 002 cases of SCD. 643 999 inhabitants were exposed to AD-medication prior to the year of follow up. The total amount of SCD in the AD cohort was 1 981 individuals. The incidence rate of SCD was significantly higher in the exposed groups compared to the general population across all age groups bar the age group 18-29 years (Figure 1). Adjusting for age, sex, and comorbidities the hazard ratio for SCD was 1.56 (1.46-1.67 p<0.001) for 1-5 years of exposure to AD, and 2.17 (2.01-2.31 p<0.001) for 6+ years of exposure of AD. In individuals ages 40-79 years, the SCD incidence rate ratio was significantly higher among persons with 6+ exposure of AD compared to persons with 1-5 years exposure (Figure 2). CONCLUSION: Exposure time to antidepressants was associated with a higher risk of SCD. Adjusted HR was 1.56 for 1-5 years of AD exposure and 2.17 for 6+ years (p-value <0.001). The risk was notably higher among individuals aged 40-79 years with longer exposure time. [Figure: see text] [Figure: see text]