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Richards-Belle A, Austin-Zimmerman I, Wang B, Zartaloudi E, Cotic M, Gracie C, Saadullah Khani N, Wannasuphoprasit Y, Wronska M, Dawda Y, Osborn DP, Bramon E. Associations of antidepressants and antipsychotics with lipid parameters: Do CYP2C19/ CYP2D6 genes play a role? A UK population-based study. J Psychopharmacol 2023; 37:396-407. [PMID: 36772859 PMCID: PMC10101178 DOI: 10.1177/02698811231152748] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Dyslipidaemia is an important cardiovascular risk factor for people with severe mental illness, contributing to premature mortality. The link between antipsychotics and dyslipidaemia is well established, while evidence on antidepressants is mixed. AIMS To investigate if antidepressant/antipsychotic use was associated with lipid parameters in UK Biobank participants and if CYP2C19 and CYP2D6 genetic variation plays a role. METHODS Review of self-reported prescription medications identified participants taking antidepressants/antipsychotics. Total, low-, and high-density lipoprotein cholesterol (L/HDL-C) and triglycerides derived from blood samples. CYP2C19 and CYP2D6 metabolic phenotypes were assigned from genetic data. Linear regression investigated aims, adjusted for key covariates. RESULTS Of 469,739 participants, 36,043 took antidepressants (53% female, median age 58, 17% taking cholesterol-lowering medications) and 3255 took antipsychotics (58% female, median age 57, 27% taking cholesterol-lowering medications). Significant associations were found between use of each amitriptyline, fluoxetine, citalopram/escitalopram, sertraline, paroxetine and venlafaxine with higher total cholesterol, LDL-C, and triglycerides and lower HDL-C, compared to participants not taking each medication. Venlafaxine was associated with the worst lipid profile (total cholesterol, adjusted mean difference: 0.21 mmol/L, 95% confidence interval (CI): 0.17 to 0.26, p < 0.001). Antipsychotic use was significantly associated with lower HDL-C and higher triglycerides. In participants taking sertraline, CYP2C19 intermediate metabolisers had higher HDL-C (0.05 mmol/L, 95% CI: 0.01 to 0.09, p = 0.007) and lower triglycerides (-0.17 mmol/L, 95% CI: -0.29 to -0.05, p = 0.007), compared to normal metabolisers. CONCLUSIONS Antidepressants were significantly associated with adverse lipid profiles, potentially warranting baseline and regular monitoring. Further research should investigate the mechanistic pathways underlying the protective effects of the CYP2C19 intermediate metaboliser phenotype on HDL-C and triglycerides in people taking sertraline.
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Affiliation(s)
- Alvin Richards-Belle
- Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK
| | - Isabelle Austin-Zimmerman
- Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Baihan Wang
- Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK
| | - Eirini Zartaloudi
- Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK
| | - Marius Cotic
- Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK
| | - Caitlin Gracie
- Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK
| | - Noushin Saadullah Khani
- Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK
| | - Yanisa Wannasuphoprasit
- Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK
| | - Marta Wronska
- Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK
| | - Yogita Dawda
- Department of Pharmacy, Central and North West London NHS Foundation Trust, London, UK
| | - David Pj Osborn
- Epidemiology and Applied Clinical Research Department, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Elvira Bramon
- Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Breeden M, Gillis A, Salas J, Scherrer JF. Antidepressant treatment and blood pressure control in patients with comorbid depression and treatment resistant hypertension. J Psychosom Res 2022; 153:110692. [PMID: 34906849 DOI: 10.1016/j.jpsychores.2021.110692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Though inconsistent, the majority of studies support an association between depression and incident hypertension and poor blood pressure control. However, none have investigated whether antidepressant medication (ADM) therapy is associated with blood pressure control in patients with comorbid depression and treatment resistant hypertension. METHODS Optum® de-identified Electronic Health Record data (2010-2018) were used to create a retrospective cohort of patients (≥18 years of age) with comorbid depression and treatment resistant hypertension. Patients were categorized into adequate ADM, inadequate ADM and no ADM treatment. A modified Poisson regression approach with robust error variance was used to estimate the association between ADM status and blood pressure control before and after adjusting for covariates. RESULTS Patients were, on average, 55.7 (SD ± 9.9) years of age, 63.9% were female, 76.2% were white and 19.2% Black race. In crude models, inadequate ADM (RR = 1.06; 95%CI:1.01-1.11) and adequate ADM (RR = 1.08; 95%CI:1.03-1.14), compared to no ADM treatment, were associated with blood pressure control. After adjusting for covariates this relationship was attenuated and no longer significant. CONCLUSIONS The modest association between ADM therapy and blood pressure control in patients with treatment resistant hypertension is largely explained by traditional risk factors for hypertension such as obesity and older age. Treating depression is not a robust factor in blood pressure control among those with treatment resistant hypertension.
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Affiliation(s)
- Matthew Breeden
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA.
| | - Auston Gillis
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
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