Impact of antidepressants use on risk of myocardial infarction: A systematic review and meta-analysis

Indian J Pharmacol. 2015 May-Jun;47(3):256-62. doi: 10.4103/0253-7613.157112.


Aims: The aim of the study was to perform a systematic review and meta-analysis to determine the association between antidepressants use and risk of myocardial infarction (MI), and whether this association differs between tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).

Methods: A PubMed/MEDLINE search was conducted for studies published up to December 2013. Included studies were evaluated for publication bias and heterogeneity. Depending on the presence of heterogeneity, a random or fixed effects model was used to identify the pooled relative risk (RR) with 95% confidence intervals (CIs). Cumulative meta-analysis, subgroup and sensitivity analyses were also performed. All analyses were performed using comprehensive meta-analysis software.

Results: Fourteen (five cohort and nine case-control) studies were included. There was heterogeneity among the studies (P heterogeneity = 0.02; I (2) = 68%) but no publication bias (Begg's P = 0.30 and Egger's P = 0.45). Antidepressants use significantly increases the risk of myocardial infarction (MI) (RR = 2.03; 95% CI = 1.30-3.18; P < 0.01). On subgroup analysis by study design, cohort studies show significant positive association (RR = 2.16; 95% CI = 1.42-3.29; P < 0.01), but not case-control studies (RR = 2.47; 95% CI = 0.69-8.90; P = 0.17). Sensitivity analysis and cumulative meta-analysis confirmed the stability of results. TCAs users are having 36% increased risk of MI after excluding one outlier (RR = 1.36; 95% CI = 1.10-1.67; P < 0.01), but SSRIs showing no association (RR = 0.84; 95% CI = 0.57-1.22; P = 0.35).

Conclusions: We found evidence that the use of antidepressants was associated with elevated risk of MI. Further research is needed to identify the underlying biological mechanisms.

Keywords: Myocardial infarction; selective serotonin reuptake inhibitors; tricyclic antidepressants.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Antidepressive Agents, Tricyclic / adverse effects*
  • Humans
  • Myocardial Infarction / chemically induced*
  • Selective Serotonin Reuptake Inhibitors / adverse effects*


  • Antidepressive Agents, Tricyclic
  • Serotonin Uptake Inhibitors