Adults with CKD: safety of antidepressants compared
In a recent Swedish/UK study by Nanbo, 2024, various antidepressants were compared in CKD patients.
Why is this important?
Depression is common in patients with CKD. Despite the widespread use of antidepressants in the CKD population, their safety remains unclear.
What did the study show?
Of 7798 people with CKD3-5, antidepressant treatment was initiated in 5743 (74%).
Compared with those not on antidepressants, initiation of antidepressants was associated with higher risk of short-term outcomes, including hip fracture (23% increased likelihood) and upper gastrointestinal bleeding (38%) – although not statistically significant.
Initiation of antidepressants was not associated with long-term outcomes, including all-cause mortality, major heart problems, CKD progression, and suicidal behavior.
Compared with SSRIs, initiation of mirtazapine was associated with a lower risk of upper gastrointestinal bleeding (52%), but a higher risk of mortality (11%).
Compared with the standard dose, initiation of SSRIs with a lower dose was associated with non-statistically significantly risk of upper gastrointestinal bleeding (68%) and CKD progression (80%) but a higher risk of cardiac arrest.
How does this affect you?
Antidepressants were commonly used in patients with CKD3-5. They were associated with some adverse short-term adverse but not long-term outcomes in people with CKD and depression. Thus these drugs should not be withheld from CKD patients. Mirtazepine perhaps should be avoided, and perhaps standard dose SSRIs used, if prescribed.
Last Reviewed on 26 June 2024
