SEROTONERGIC ANTIDEPRESSANT USE AND MORBIDITY AND MORTALITY AMONG OLDER ADULTS WITH COPD

Abstract

We evaluated the relationship between new selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI) drug use and respiratory-related morbidity and mortality among older adults with chronic obstructive pulmonary disease (COPD).

This was retrospective, population-based, cohort study using Ontario, Canada, heath administrative data. Individuals ages 66 years of age and older, with validated, physician-diagnosed COPD (n=131,718) were included. New SSRI/SNRI users were propensity score matched 1:1 to controls on 40 relevant covariates to minimize potential confounding.

Among propensity-scored matched community-dwelling individuals, new SSRI/SNRI users compared to non-users had significantly higher rates of hospitalization for COPD or pneumonia (hazard ratio [HR] 1.15; 95% confidence interval [CI] 1.05–1.25), ER visits for COPD or pneumonia (HR 1.13; 95% CI 1.03–1.24), COPD or pneumonia-related mortality (HR 1.26; 95% CI 1.03–1.55) and all-cause mortality (HR 1.20; 95% CI 1.11–1.29). Respiratory-specific and all-cause mortality rates were also higher among long term care home residents newly starting SSRI/SNRI drugs versus controls.

New use of serotonergic antidepressants was associated with small, but significant, increases in rates of respiratory-related morbidity and mortality among older adults with COPD. Further research is needed to clarify if the observed associations are causal or instead reflect unresolved confounding.