" 'Antidepressant medications reduce symptoms of depression, but there are now concerns that treatment with these agents may increase rather than decrease the risk for suicide, especially when treatment is initiated or medication dosages changed,' noted Zhiguo Li, PhD, Institute for Social Research, University of Michigan, Ann Arbor, Michigan.http://www.docguide.com/news/content.nsf/news/852576140048867C852576E10061ADC8
Antidepressant Initiation May Raise Risk for Anxiety in Depressed Patients: Presented at ADAA
- By Liz Meszaros
BALTIMORE, Md — March 9, 2010 — Initiation of antidepressant therapy may increase the risk of developing anxiety in certain patients, according to a study presented here at the Anxiety Disorders Association of America 30th Annual Conference (ADAA).
At particular risk are those with major depression, those of a younger age, women, and white and Hispanic individuals, researchers said here on March 5.
Previous studies have shown that individuals with anxiety disorders are at higher risk for suicide, as are those with psychiatric disorders, especially depressive disorders.
"Antidepressant medications reduce symptoms of depression, but there are now concerns that treatment with these agents may increase rather than decrease the risk for suicide, especially when treatment is initiated or medication dosages changed," noted Zhiguo Li, PhD, Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
Dr. Li and colleagues enrolled individuals from the Veterans Affairs (VA) National Registry for Depression, which includes data for >1 million patients from VA facilities throughout the United States who are diagnosed with depressive disorders from 1997 forward.
To be included in this study, patients must have received at least 2 clinical diagnoses of depression or 1 diagnosis followed by antidepressant therapy between April 1, 1999, and September 30, 2004. Of the 372,573 subjects included in the study, 6.1% (n = 22,755) developed anxiety. Of these, 3.7% were being treated with an antianxiety medication, 2.7% had an anxiety diagnosis at baseline, and 0.3% had both.
Of patients being treated with an antianxiety medication, 27.7% were taking sertraline, 26.1% citalopram, 14.8% fluoxetine, 12.2% paroxetine, 11.4% bupropion, 4.0% venlafaxine, and 3.8% mirtazapine.
The presence of major depression increased the risk of developing anxiety (adjusted hazard ratio [HR] = 1.328; 95% confidence interval [CI], 1.288-1.370; P < .001). Patients taking >=1 psychotropic medication in the past 12 months (HR = 1.386; 95% CI, 1.303-1.474; P < .001) and women (HR = 1.187; 95% CI, 1.134-1.243; P < .001) were also at increased risk.
Fluoxetine, sertraline, and bupropion were associated with lower risks of developing anxiety than citalopram, mirtazapine, paroxetine, and venlafaxine. A higher risk was seen in younger patients, women, and white and Hispanic subjects compared with older subjects, men, and non-Hispanic subjects.
"A meta-analysis in a [US Food and Drug Administration] memorandum in November 2006 pointed out that younger age is associated with higher risks of antidepressant-induced suicide," said the researchers. "Our finding that younger age is associated with higher risks of anxiety development after antidepressant initiation coincides and helps to explain this," they concluded.
[Presentation title: Development of Anxiety After Antidepressant Use Among Depressed Veterans. Abstract 173]