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Association of Antidepressant Use with Adverse Health Outcomes: A Systematic Umbrella Review

Research output: Contribution to journalReview article

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Association of Antidepressant Use with Adverse Health Outcomes : A Systematic Umbrella Review. / Dragioti, Elena; Solmi, Marco; Favaro, Angela; Fusar-Poli, Paolo; Dazzan, Paola; Thompson, Trevor; Stubbs, Brendon; Firth, Joseph; Fornaro, Michele; Tsartsalis, Dimitrios; Carvalho, Andre F.; Vieta, Eduard; McGuire, Philip; Young, Allan H.; Shin, Jae Il; Correll, Christoph U.; Evangelou, Evangelos.

In: JAMA Psychiatry, Vol. 76, No. 12, 12.2019, p. 1241-1255.

Research output: Contribution to journalReview article

Harvard

Dragioti, E, Solmi, M, Favaro, A, Fusar-Poli, P, Dazzan, P, Thompson, T, Stubbs, B, Firth, J, Fornaro, M, Tsartsalis, D, Carvalho, AF, Vieta, E, McGuire, P, Young, AH, Shin, JI, Correll, CU & Evangelou, E 2019, 'Association of Antidepressant Use with Adverse Health Outcomes: A Systematic Umbrella Review', JAMA Psychiatry, vol. 76, no. 12, pp. 1241-1255. https://doi.org/10.1001/jamapsychiatry.2019.2859

APA

Dragioti, E., Solmi, M., Favaro, A., Fusar-Poli, P., Dazzan, P., Thompson, T., ... Evangelou, E. (2019). Association of Antidepressant Use with Adverse Health Outcomes: A Systematic Umbrella Review. JAMA Psychiatry, 76(12), 1241-1255. https://doi.org/10.1001/jamapsychiatry.2019.2859

Vancouver

Dragioti E, Solmi M, Favaro A, Fusar-Poli P, Dazzan P, Thompson T et al. Association of Antidepressant Use with Adverse Health Outcomes: A Systematic Umbrella Review. JAMA Psychiatry. 2019 Dec;76(12):1241-1255. https://doi.org/10.1001/jamapsychiatry.2019.2859

Author

Dragioti, Elena ; Solmi, Marco ; Favaro, Angela ; Fusar-Poli, Paolo ; Dazzan, Paola ; Thompson, Trevor ; Stubbs, Brendon ; Firth, Joseph ; Fornaro, Michele ; Tsartsalis, Dimitrios ; Carvalho, Andre F. ; Vieta, Eduard ; McGuire, Philip ; Young, Allan H. ; Shin, Jae Il ; Correll, Christoph U. ; Evangelou, Evangelos. / Association of Antidepressant Use with Adverse Health Outcomes : A Systematic Umbrella Review. In: JAMA Psychiatry. 2019 ; Vol. 76, No. 12. pp. 1241-1255.

Bibtex Download

@article{a9c7f0fe615c469c8ab9bd32439810b9,
title = "Association of Antidepressant Use with Adverse Health Outcomes: A Systematic Umbrella Review",
abstract = "Importance: Antidepressant use is increasing worldwide. Yet, contrasting evidence on the safety of antidepressants is available from meta-analyses, and the credibility of these findings has not been quantified. Objective: To grade the evidence from published meta-analyses of observational studies that assessed the association between antidepressant use or exposure and adverse health outcomes. Data Sources: PubMed, Scopus, and PsycINFO were searched from database inception to April 5, 2019. Evidence Review: Only meta-analyses of observational studies with a cohort or case-control study design were eligible. Two independent reviewers recorded the data and assessed the methodological quality of the included meta-analyses. Evidence of association was ranked according to established criteria as follows: convincing, highly suggestive, suggestive, weak, or not significant. Results: Forty-five meta-analyses (17.9{\%}) from 4471 studies identified and 252 full-text articles scrutinized were selected that described 120 associations, including data from 1012 individual effect size estimates. Seventy-four (61.7{\%}) of the 120 associations were nominally statistically significant at P ≤.05 using random-effects models. Fifty-two associations (43.4{\%}) had large heterogeneity (I2 > 50{\%}), whereas small-study effects were found for 17 associations (14.2{\%}) and excess significance bias was found for 9 associations (7.5{\%}). Convincing evidence emerged from both main and sensitivity analyses for the association between antidepressant use and risk of suicide attempt or completion among children and adolescents, autism spectrum disorders with antidepressant exposure before and during pregnancy, preterm birth, and low Apgar scores. None of these associations remained supported by convincing evidence after sensitivity analysis, which adjusted for confounding by indication. Conclusions and Relevance: This study's findings suggest that most putative adverse health outcomes associated with antidepressant use may not be supported by convincing evidence, and confounding by indication may alter the few associations with convincing evidence. Antidepressant use appears to be safe for the treatment of psychiatric disorders, but more studies matching for underlying disease are needed to clarify the degree of confounding by indication and other biases. No absolute contraindication to antidepressants emerged from this umbrella review.",
author = "Elena Dragioti and Marco Solmi and Angela Favaro and Paolo Fusar-Poli and Paola Dazzan and Trevor Thompson and Brendon Stubbs and Joseph Firth and Michele Fornaro and Dimitrios Tsartsalis and Carvalho, {Andre F.} and Eduard Vieta and Philip McGuire and Young, {Allan H.} and Shin, {Jae Il} and Correll, {Christoph U.} and Evangelos Evangelou",
year = "2019",
month = "12",
doi = "10.1001/jamapsychiatry.2019.2859",
language = "English",
volume = "76",
pages = "1241--1255",
journal = "JAMA Psychiatry",
issn = "2168-622X",
publisher = "American Medical Association",
number = "12",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Association of Antidepressant Use with Adverse Health Outcomes

T2 - A Systematic Umbrella Review

AU - Dragioti, Elena

AU - Solmi, Marco

AU - Favaro, Angela

AU - Fusar-Poli, Paolo

AU - Dazzan, Paola

AU - Thompson, Trevor

AU - Stubbs, Brendon

AU - Firth, Joseph

AU - Fornaro, Michele

AU - Tsartsalis, Dimitrios

AU - Carvalho, Andre F.

AU - Vieta, Eduard

AU - McGuire, Philip

AU - Young, Allan H.

AU - Shin, Jae Il

AU - Correll, Christoph U.

AU - Evangelou, Evangelos

PY - 2019/12

Y1 - 2019/12

N2 - Importance: Antidepressant use is increasing worldwide. Yet, contrasting evidence on the safety of antidepressants is available from meta-analyses, and the credibility of these findings has not been quantified. Objective: To grade the evidence from published meta-analyses of observational studies that assessed the association between antidepressant use or exposure and adverse health outcomes. Data Sources: PubMed, Scopus, and PsycINFO were searched from database inception to April 5, 2019. Evidence Review: Only meta-analyses of observational studies with a cohort or case-control study design were eligible. Two independent reviewers recorded the data and assessed the methodological quality of the included meta-analyses. Evidence of association was ranked according to established criteria as follows: convincing, highly suggestive, suggestive, weak, or not significant. Results: Forty-five meta-analyses (17.9%) from 4471 studies identified and 252 full-text articles scrutinized were selected that described 120 associations, including data from 1012 individual effect size estimates. Seventy-four (61.7%) of the 120 associations were nominally statistically significant at P ≤.05 using random-effects models. Fifty-two associations (43.4%) had large heterogeneity (I2 > 50%), whereas small-study effects were found for 17 associations (14.2%) and excess significance bias was found for 9 associations (7.5%). Convincing evidence emerged from both main and sensitivity analyses for the association between antidepressant use and risk of suicide attempt or completion among children and adolescents, autism spectrum disorders with antidepressant exposure before and during pregnancy, preterm birth, and low Apgar scores. None of these associations remained supported by convincing evidence after sensitivity analysis, which adjusted for confounding by indication. Conclusions and Relevance: This study's findings suggest that most putative adverse health outcomes associated with antidepressant use may not be supported by convincing evidence, and confounding by indication may alter the few associations with convincing evidence. Antidepressant use appears to be safe for the treatment of psychiatric disorders, but more studies matching for underlying disease are needed to clarify the degree of confounding by indication and other biases. No absolute contraindication to antidepressants emerged from this umbrella review.

AB - Importance: Antidepressant use is increasing worldwide. Yet, contrasting evidence on the safety of antidepressants is available from meta-analyses, and the credibility of these findings has not been quantified. Objective: To grade the evidence from published meta-analyses of observational studies that assessed the association between antidepressant use or exposure and adverse health outcomes. Data Sources: PubMed, Scopus, and PsycINFO were searched from database inception to April 5, 2019. Evidence Review: Only meta-analyses of observational studies with a cohort or case-control study design were eligible. Two independent reviewers recorded the data and assessed the methodological quality of the included meta-analyses. Evidence of association was ranked according to established criteria as follows: convincing, highly suggestive, suggestive, weak, or not significant. Results: Forty-five meta-analyses (17.9%) from 4471 studies identified and 252 full-text articles scrutinized were selected that described 120 associations, including data from 1012 individual effect size estimates. Seventy-four (61.7%) of the 120 associations were nominally statistically significant at P ≤.05 using random-effects models. Fifty-two associations (43.4%) had large heterogeneity (I2 > 50%), whereas small-study effects were found for 17 associations (14.2%) and excess significance bias was found for 9 associations (7.5%). Convincing evidence emerged from both main and sensitivity analyses for the association between antidepressant use and risk of suicide attempt or completion among children and adolescents, autism spectrum disorders with antidepressant exposure before and during pregnancy, preterm birth, and low Apgar scores. None of these associations remained supported by convincing evidence after sensitivity analysis, which adjusted for confounding by indication. Conclusions and Relevance: This study's findings suggest that most putative adverse health outcomes associated with antidepressant use may not be supported by convincing evidence, and confounding by indication may alter the few associations with convincing evidence. Antidepressant use appears to be safe for the treatment of psychiatric disorders, but more studies matching for underlying disease are needed to clarify the degree of confounding by indication and other biases. No absolute contraindication to antidepressants emerged from this umbrella review.

UR - http://www.scopus.com/inward/record.url?scp=85073050563&partnerID=8YFLogxK

U2 - 10.1001/jamapsychiatry.2019.2859

DO - 10.1001/jamapsychiatry.2019.2859

M3 - Review article

C2 - 31577342

AN - SCOPUS:85073050563

VL - 76

SP - 1241

EP - 1255

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

IS - 12

ER -

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