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Risk of Suicide in Users of Cardiovascular Drugs

A Review of the Epidemiological Evidence

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Abstract

An association between consumption of cardiovascular drugs and increased risk of depression was first reported more than 30 years ago. More recently three observational studies have also reported an association between the use of cardiovascular drugs and risk of suicide. We review the epidemiological evidence with particular focus on bias, confounding, and chance as alternative explanations to a causal association. The results of the three studies are inconsistent with respect to the association between cardiovascular drug use and suicide. None of the studies has been able to control fully for possible confounding, in particular by the underlying disease and comorbidity.

We thus conclude that the finding of an association between suicide risk and cardiovascular drug use remains dubious. A true explanation for the apparent increase in risk of suicide in users of cardiovascular drugs remains unknown. Future studies must try to reduce confounding. Meta-analyses of data from existing trials may be an approach to solve the problem of confounding.

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References

  1. Waal HJ. Propranolol-induced depression (letter). BMJ 1967; 2(543): 50

    Article  PubMed  CAS  Google Scholar 

  2. Avorn J, Everitt DE, Weiss S. Increased antidepressant use in patients prescribed beta-blockers. JAMA 1986 Jan 17; 255(3): 357–60

    Article  PubMed  CAS  Google Scholar 

  3. Hallas J. Evidence of depression provoked by cardiovascular medication: a prescription sequence symmetry analysis. Epidemiology 1996 Sep; 7(5): 478–84

    Article  PubMed  CAS  Google Scholar 

  4. Patten SB. Propranolol and depression: evidence from the antihypertensive trials. Can J Psychiatry 1990 Apr; 35(3): 257–9

    PubMed  CAS  Google Scholar 

  5. Biriell C, McEwen J, Sanz E. Depression associated with diltiazem (letter). BMJ 1989; 299(6702): 796

    Article  PubMed  CAS  Google Scholar 

  6. Patten SB, Williams JV, Love EJ. Case-control studies of cardiovascular medications as risk factors for clinically diagnosed depressive disorders in a hospitalized population. Can J Psychiatry 1996 Sep; 41(7): 469–76

    PubMed  CAS  Google Scholar 

  7. Dunn NR, Freemantle SN, Mann RD. Cohort study on calcium channel blockers, other cardiovascular agents, and the prevalence of depression. Br J Clin Pharmacol 1999 Aug; 48(2): 230–3

    Article  PubMed  CAS  Google Scholar 

  8. Lindberg G, Bingefors K, Ranstam J, et al. Use of calcium channel blockers and risk of suicide: ecological findings confirmed in population based cohort study. BMJ 1998 Mar 7; 316(7133): 741–5

    Article  PubMed  CAS  Google Scholar 

  9. Sørensen HT, Mellemkj≸r L, Olsen JH. Risk of suicide in users of beta-adrenoceptor blockers, calcium channel blockers and angiotensin converting enzyme inhibitors. Br J Clin Pharmacol 2001 Sep; 52(3): 313–8

    Article  PubMed  Google Scholar 

  10. Hullett FJ, Potkin SG, Levy AB, et al. Depression associated with nifedipine-induced calcium channel blockade. Am J Psychiatry 1988 Oct; 145(10): 1277–9

    PubMed  CAS  Google Scholar 

  11. Dassylva B. Verapamil may cause depression. Can J Psychiatry 1993 May; 38(4): 299–300

    PubMed  CAS  Google Scholar 

  12. McAllister-Williams RH. Calcium-channel blockade and depressive illness. Br J Psychiatry 1990 Oct; 157: 618–9

    Article  PubMed  CAS  Google Scholar 

  13. bergman U, Isacsson G. Use of calcium channel blockers and risk of suicide: independent studies are needed before causality is established (letter). BMJ 1998; 317(7165): 1076

    Article  PubMed  CAS  Google Scholar 

  14. Wiholm BE, Sundstrom A, Alfredsson L. Use of calcium channel blockers and risk of suicide: drug prescriptions over longer period should have been followed up. BMJ 1998 Oct 17; 317(7165): 1076–7

    Article  PubMed  CAS  Google Scholar 

  15. Chen YT, Makuch RW. Use of calcium channel blockers and risk of suicide: prescriptions for particular drug are influenced by numerous factors (letter). BMJ 1998; 317(7165): 1077

    Article  PubMed  CAS  Google Scholar 

  16. Gasse C, Derby LE, Vasilakis C, et al. Risk of suicide among users of calcium channel blockers: population based, nested case-control study (short report). BMJ 2000; 320(7244): 1251

    Article  PubMed  CAS  Google Scholar 

  17. Fletcher RH, Fletcher SW, Wagner EH. Clinical epidemiology: the essentials. 3rd ed. Baltimore: Williams & Wilkins, 1996

    Google Scholar 

  18. Rothman KJ, Greenland S. Modern epidemiology. 2nd ed. Philadelphia (PA): Lippincott Williams & Wilkins, 1998

    Google Scholar 

  19. Olsen JH, Sørensen HT, Friis S, et al. Cancer risk in users of calcium channel blockers. Hypertension 1997 May; 29(5): 1091–4

    Article  PubMed  CAS  Google Scholar 

  20. Stanton AV. Calcium channel blockers: the jury is still out on whether they cause heart attacks and suicide. BMJ 1998 May 16; 316(7143): 1471–3

    Article  PubMed  CAS  Google Scholar 

  21. Ried LD, McFarland BH, Johnson RE, et al. Beta-blockers and depression: the more the murkier? Ann Pharmacother 1998 Jun; 32(6): 699–708

    Article  PubMed  CAS  Google Scholar 

  22. Den Almindelige Danske Lægeforening. Lægeforeningens Medicinfortegnelse. 24th ed. Copenhagen: Lægeforeningens Forlag, 2001

    Google Scholar 

  23. Kyvik KO, Stenager EN, Green A, et al. Suicides in men with IDDM. Diabetes Care 1994 Mar; 17(3): 210–2

    Article  PubMed  CAS  Google Scholar 

  24. Lindberg G, Ranstam J, Melander A, et al. Authors reply (letter). BMJ 1998; 317(7165): 1077

    Article  Google Scholar 

  25. Patten SB, Love EJ. Drug-induced depression. Psychother Psychosom 1997; 66(2): 63–73

    Article  PubMed  CAS  Google Scholar 

  26. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the scale for suicide ideation. J Consult Clin Psychol 1979 Apr; 47(2): 343–52

    Article  PubMed  CAS  Google Scholar 

  27. PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. Lancet 1998 Nov 7; 352(9139): 1498–504

    Article  Google Scholar 

  28. Conant J, Engler R, Janowsky D, et al. Central nervous system side effects of beta-adrenergic blocking agents with high and low lipid solubility. J Cardiovasc Pharmacol 1989 Apr; 13(4): 656–61

    PubMed  CAS  Google Scholar 

  29. Opie LH. Angiotensin-converting enzyme inhibitors: the advance continues. 3rd ed. New York: Authors’ Publishing House, 1999

    Google Scholar 

  30. Pucilowski O. Psychopharmacological properties of calcium channel inhibitors. Psychopharmacology (Berl) 1992; 109(1–2): 12–29

    Article  CAS  Google Scholar 

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Acknowledgements

This study has received financial support from the Western Danish Research Forum for Health Sciences.

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Correspondence to Peter Jepsen.

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Jepsen, P., Johnsen, S.P. & Sørensen, H.T. Risk of Suicide in Users of Cardiovascular Drugs. Am J Cardiovasc Drugs 3, 163–167 (2003). https://doi.org/10.2165/00129784-200303030-00002

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