Some Antidepressants May Raise Risk for Gastro Infection

Researchers aren't sure why these meds are linked to chances of contracting C. difficile

By Robert Preidt

HealthDay Reporter

TUESDAY, May 7 (HealthDay News) -- People who take certain types of antidepressants may be at higher risk for potentially deadly Clostridium difficile infection, a new study suggests.

This type of infection is one of the most common caught by hospital patients and causes more than 7,000 deaths each year in the United States. Several medications are thought to increase the risk for this infection, including antidepressants.

In this study, University of Michigan researchers examined C. difficile infection in people with and without depression, and found that those with major depression had a 36 percent higher risk than those without depression. Older, widowed people were 54 percent more likely to catch C. difficile than older married people. People who lived alone had a 25 percent higher risk than those who lived with others.

The researchers then investigated if there was a link between antidepressants and C. difficile infection. They found that only two -- Remeron (mirtazapine) and Prozac (fluoxetine) -- increased the risk, and that each drug doubled the risk.

The findings, published May 6 in the journal BMC Medicine, should improve identification and early treatment of C. difficile infection in people taking these antidepressants, the researchers said.

The reason for the increased risk of infection in people taking the antidepressants is unknown, and people who have been prescribed the drugs need to keep taking them unless their doctor tells them otherwise, the researchers said. The research showed an association between antidepressant use and increased risk of contracting the infection, but it did not prove a cause-and-effect link.

"Depression is common worldwide," study leader Dr. Mary Rogers said in a university news release. "We have long known that depression is associated with changes in the gastrointestinal system."

"The interaction between the brain and the gut, called the 'brain-gut axis,' is fascinating and deserves more study," Rogers said. "Our finding of a link between depression and Clostridium difficile should help us better identify those at risk of infection and perhaps encourage exploration of the underlying brain-gut mechanisms involved."

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Antidepressants May Be Helpful for Some Heart Patients: Study

Emotional stress can harm cardiovascular health, experts say, so boosting mental resilience may be key

By Mary Elizabeth Dallas

HealthDay Reporter

TUESDAY, May 21 (HealthDay News) -- Use of the antidepressant Lexapro appears to help prevent a potentially serious stress-related heart condition, a new study finds.

The condition is known as known as "mental stress-induced myocardial ischemia." Although people with this condition may not develop noticeable symptoms, their heart muscle is not receiving adequate blood supply, according to researchers from Duke University School of Medicine in Durham, N.C.

However, the researchers found that people taking the antidepressant Lexapro (escitalopram) were more than two and a half times less likely to be affected by the condition, which can be spurred by emotional stress.

The study was funded by the U.S. National Heart, Lung, and Blood Institute and is published in the May 22 issue of the Journal of the American Medical Association.

"Mental stress-induced myocardial ischemia is a serious condition, as patients with the condition tend to have worse heart problems compared to patients without it," study author Dr. Wei Jiang, an associate professor of psychiatry and behavioral sciences and internal medicine at Duke, said in a university news release. "This study showed for the first time that it is treatable with an emotion-modulating medication."

The study involved 310 people diagnosed with heart disease whose condition was stable and under control. To identify those with the stress-linked heart condition, the researchers first had participants undergo exercise stress tests on a treadmill. They also had to complete three mental stress tests: First they had to solve a difficult math problem, then trace a star while looking at their hand movements in a mirror, and then tell a story that made them feel sad or angry.

As the participants performed these tasks, they underwent echocardiograms and electrocardiograms, and had readings taken of blood pressure and heart rate.

According to Jiang's team, 127 of the patients developed stress-related heart issues. These patients were assigned to take either Lexapro, a selective serotonin reuptake inhibitor (SSRI) that's commonly used to treat depression and anxiety, or a placebo pill.

After six weeks, the participants retook the stress tests and had their heart function re-assessed. Of the original 127, 112 completed the study. The researchers found those who took the antidepressant drug were nearly three times less likely to develop stress-linked cardiovascular trouble during the mental stress tests compared to those taking placebo.

Patients taking Lexapro also tended to have healthy changes in heart function and they reported feeling calmer and more controlled than the placebo group.

"Our findings support the hypothesis that short-term use of SSRIs improves levels of biomarkers associated with adverse cardiovascular outcomes," explained Jiang. Other SSRIs include Celexa, Paxil, Prozac and Zoloft.

The researchers concluded that SSRIs or other antidepressant treatments could help manage heart disease. They noted that more research is needed to determine the proper dosing of Lexapro for the treatment of stress-linked heart issues and to better understand how antidepressant drugs could also affect patients' risk for serious health conditions, including heart attack or angina, stroke, heart failure, or death.

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Antidepressants Celexa, Lexapro Tied to Irregular Heartbeat: Study

TUESDAY, Jan. 29 (HealthDay News) -- People taking certain antidepressants, including Celexa and Lexapro, may have a slightly increased risk of developing an abnormal heart beat.

Researchers say the drugs, which are in a class of medications called selective serotonin reuptake inhibitors (SSRIs), may extend the length of electrical activity in the heart, called a QT interval. A long QT interval is an indicator of abnormal heart rhythms.

"For people who are taking higher doses of citalopram (Celexa) or escitalopram (Lexapro), they should discuss these doses with their doctors," said lead researcher Dr. Roy Perlis, director of the Center for Experimental Drugs and Diagnostics in the psychiatry department at Massachusetts General Hospital in Boston.

"They should absolutely not just stop their medicine," he added.

QT interval is just one indicator of cardiac risk, so there are many other factors to consider in choosing a depression treatment, Perlis said. "It's important to know that there are other medicines which appear to be safe in terms of effects on heart rhythm," he added.

The report was published in the Jan. 29 online edition of the journal BMJ.

Doctors use an electrocardiogram (ECG) to measure the QT interval. The interval varies with heart rate, lengthening when the heart beats slower and shortening when the heart beats faster.

The normal QT interval for men is less than 420 milliseconds and for women it is less than 440 milliseconds. When the timing gets longer, the risk for abnormal heart rhythms increases, the researchers noted.

The U.S. Food and Drug Administration warned recently that Celexa and drugs like it could cause this problem.

To shed light on the matter, Perlis' team collected data on more than 38,000 adults who had an ECG after using antidepressants or methadone between February 1990 and August 2011. They found patients taking Celexa, Lexapro, Elavil (amitriptyline) and methadone had a small but significantly longer QT interval. This effect grew as dosage increased, they noted.

Nearly one in five patients taking these drugs had longer QT intervals, the study found. Whether this effect is clinically significant, however, isn't known.

"For people who need to take antidepressant doses higher than 40 milligrams of citalopram, there are a number of safe alternatives," Perlis said.

Other antidepressants were not associated with longer QT intervals. In one case, the opposite occurred.

"To our surprise, we also found that another antidepressant, bupropion (Wellbutrin, Zyban), actually shortens QT interval, though we don't know whether this is beneficial or just another indication that it is safe from a cardiac perspective," he said.

In the study, the researchers took other risk factors into account, such as age, race, sex, history of depression, heart attack, high blood pressure, heart rhythm problems and pre-existing conditions. They included methadone because it is also known to cause a longer QT interval.

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Antidepressants During Pregnancy: Safe?

Jan. 1, 2013 -- Antidepressant use during pregnancy, long debated for its safety, is linked with a higher overall risk of stillbirth and newborn death. Now, a new study shows that risk may not be warranted.

"After taking maternal characteristics such as smoking and maternal age into account, as well as previous hospitalization for psychiatric disease ... there was no association between SSRI (antidepressants) and stillbirth and infant [death]," says researcher Olof Stephansson, MD, PhD, of the Karolinksa Institutet in Stockholm.

The Swedish study included more than 1.6 million births in five Nordic countries. Nearly 30,000 of the women had filled a prescription for an SSRI (selective serotonin reuptake inhibitor) during pregnancy.

But a U.S.-based expert has some concerns about the study.

"This study looked at information on dispensed drugs, not ingested drugs, and these numbers are often quite different," says Adam Urato, MD, assistant professor of obstetrics and gynecology at Tufts University School of Medicine.

That could result in inaccurate findings, he says. "I don't find the study results particularly reassuring," he says.

Up to 19% of pregnant women have depression during pregnancy, according to the researchers. The depression itself is linked with ill effects, including an increased risk of early delivery, which in turn may cause harm to the newborn.

The new research was funded by the Swedish Pharmacy Company.

The study is published in the Journal of the American Medical Association.

Previous research about SSRI use during pregnancy has suggested it may be linked with an increased risk of prematurity, stillbirths, and birth defects. Some studies show an increased risk of miscarriage and other problems. 

The three areas the researchers focused on were stillbirths and newborn and infant deaths. The researchers compared the birth outcomes for the women who took SSRIs and those who did not from 1996 through 2007. They got information on the use of SSRIs  from prescription registries.

This type of antidepressant is the most-often prescribed for depression during pregnancy, the researchers say.

Overall, more than 6,000 babies were stillborn. More than 3,600 died as newborns, and another 1,578 died later, from ages 28 days old to 364 days old.

Women registered with an SSRI prescription had higher stillbirth rates -- 4.62 for every 1,000, compared to 3.69 per 1,000 for women who were not on the drugs.

Women registered with an SSRI prescription also had a higher risk of their infants dying at ages 28 days to just under a year.

The rates of early newborn death were similar between groups.

Next, the researchers took into account factors that could have played a role in stillbirths or infant deaths. These included the mother's age, cigarette smoking, and the severity of the mother's psychiatric disease.

When they took those risk factors into account, they found no substantial link between the antidepressant use and risks of stillbirth or death.

Even so, the researchers say women need to discuss SSRI use with their doctor to weigh the pros and cons. "Always discuss medication for depression with your obstetrician in early pregnancy for advice," Stephansson says.

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