ISTANBUL, TURKEY — The use of tricyclic antidepressants to treat depression and/or anxiety was associated with a sharply increased risk of metabolic syndrome, compared with other antidepressant classes in a large prospective Dutch cohort study.
The components of the metabolic syndrome exacerbated by tricyclic antidepressants (TCAs) were hypertension, abdominal obesity, and hypertriglyceridemia, Arianne K.B. van Reedt Dortland reported at the annual congress of the European College of Neuropsychopharmacology.
The take-home messages of this analysis from the Netherlands Study of Depression and Anxiety (NESDA) are, one, it's important to screen for these elements of the metabolic syndrome in patients who are being considered for TCA therapy or who are already on it, and, two, when one or more of these elements is present, an alternative type of antidepressant is preferable, according to Ms. van Reedt Dortland of Leiden (the Netherlands) University Medical Center.
NESDA is an ongoing 8-year prospective multicenter study involving 261 patients with current major depressive disorder only, 266 with a current pure anxiety disorder, and 690 with both, all diagnosed using DSM-IV criteria. A total of 328 patients were treated with a selective serotonin reuptake inhibitor, 49 received a TCA, 110 were on a serotonergic/noradrenergic reuptake inhibitor, and 730 were not on antidepressant medication.
During the first 4 years of follow-up, patients on a TCA were at a 2.3-fold increased risk of meeting criteria for the metabolic syndrome after adjustment for age, gender, physical activity, years of education, smoking status, and alcohol use, compared with patients not on antidepressant medication. Specifically, patients on TCA therapy were at 2.3-fold increased risk for hypertension, 1.9-fold increased risk for abdominal obesity, and 2.6-fold increased risk for hypertriglyceridemia. The use of SSRIs or selective nore-phinephrine reuptake inhibitors was not associated with an increased rate of metabolic syndrome. Dr. Dortland reported having no conflicts of interest.