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Table 3 Unadjusted and adjusted 5-year hazard ratios for epilepsy/seizures by antidepressant class, dose, duration and individual drug

From: Antidepressant use and risk of epilepsy and seizures in people aged 20 to 64 years: cohort study using a primary care database

 

No. of eventsa

Person yearsb

Unadjusted analyses

Adjustedc analyses

HR

95 % CI

P

HR

95 % CI

P

Antidepressant class

          

 No current use

384

566,890

1.00

   

1.00

   

 TCAs

82

41,130

2.83

2.22

3.62

<0.001

2.32

1.79

3.01

<0.001

 SSRIs

309

224,600

1.97

1.69

2.31

<0.001

1.92

1.63

2.25

<0.001

 Other antidepressants

58

27,820

3.11

2.39

4.05

<0.001

2.33

1.76

3.10

<0.001

 Combined antidepressants

13

4220

4.70

2.77

7.98

<0.001

2.73

1.52

4.91

0.001

Antidepressant class and dose categoriesd

         

 No current use

384

566,890

1.00

   

1.00

   

 TCA: ≤ 0.5 DDD

38

23,520

2.26

1.59

3.21

<0.001

1.91

1.32

2.76

0.001

 TCA: >0.5 DDD/≤ 1.0 DDD

28

8370

4.85

3.31

7.11

<0.001

3.65

2.46

5.42

<0.001

 TCA: > 1.0 DDD

14

5240

3.69

2.18

6.24

<0.001

2.94

1.72

5.03

<0.001

 SSRI: ≤ 0.5 DDD

19

15,970

1.67

1.06

2.61

0.027

1.80

1.15

2.84

0.011

 SSRI: >0.5 DDD/≤ 1.0 DDD

213

157,490

1.92

1.60

2.30

<0.001

1.90

1.57

2.29

<0.001

 SSRI: > 1.0 DDD

67

42,410

2.31

1.80

2.97

<0.001

2.03

1.56

2.64

<0.001

 Other: ≤ 0.5 DDD

6

4000

2.09

0.95

4.61

0.068

1.71

0.77

3.82

0.187

 Other: >0.5 DDD/≤ 1.0 DDD

31

13,090

3.71

2.64

5.20

<0.001

2.66

1.85

3.83

<0.001

 Other: > 1.0 DDD

19

8330

3.21

2.01

5.13

<0.001

2.54

1.56

4.11

<0.001

 Combined antidepressants

13

4220

4.70

2.77

7.97

<0.001

2.73

1.52

4.91

0.001

Antidepressant class by duration

          

 No current usee

333

508,970

1.00

   

1.00

   

 TCA first 28 days

12

5470

2.85

1.52

5.36

0.001

2.40

1.28

4.47

0.006

 TCA 29 to 84 days

16

5380

4.65

2.86

7.59

<0.001

3.76

2.29

6.18

<0.001

 TCA 85 or more days

36

18,900

2.86

2.02

4.05

<0.001

2.16

1.49

3.14

<0.001

 SSRI first 28 days

27

20,590

1.67

0.94

2.95

0.079

1.61

0.92

2.83

0.098

 SSRI 29 to 84 days

36

27,800

2.14

1.46

3.12

<0.001

2.03

1.39

2.97

<0.001

 SSRI 85 or more days

185

127,070

2.17

1.81

2.61

<0.001

2.07

1.70

2.51

<0.001

 Other first 28 days

10

2750

4.96

2.58

9.53

<0.001

3.93

2.04

7.56

<0.001

 Other 29 to 84 days

3

3480

1.71

0.64

4.57

0.283

1.02

0.33

3.21

0.968

 Other 85 or more days

30

16,740

2.78

1.96

3.95

<0.001

2.03

1.41

2.94

<0.001

 Combined, all time

13

3850

5.35

3.15

9.09

<0.001

2.99

1.65

5.40

<0.001

 TCA 1–28 days after stopping

3

3610

1.28

0.41

3.95

0.668

1.14

0.37

3.54

0.818

 TCA 29–84 days after stopping

15

7020

3.12

1.86

5.24

<0.001

2.79

1.65

4.72

<0.001

 TCA 85–182 days after stopping

8

10,690

1.30

0.69

2.45

0.425

0.95

0.47

1.92

0.880

 SSRI 1–28 days after stopping

23

15,640

2.24

1.47

3.39

<0.001

2.28

1.50

3.46

<0.001

 SSRI 29–84 days after stopping

33

30,320

1.66

1.14

2.44

0.009

1.60

1.07

2.37

0.021

 SSRI 85–182 days after stopping

41

46,690

1.31

0.94

1.81

0.109

1.25

0.89

1.76

0.197

 Other 1–28 days after stopping

3

1560

2.86

0.93

8.79

0.067

2.39

0.77

7.39

0.131

 Other 29–84 days after stopping

11

2990

5.79

3.27

10.28

<0.001

4.46

2.46

8.09

<0.001

 Other 85–182 days after stopping

8

4490

2.52

1.25

5.08

0.010

2.17

1.08

4.36

0.030

 Combined 1–182 days after stoppingf

0

660

n/a

-

-

-

n/a

-

-

-

Antidepressant drug

          

 No current use

384

566,890

1.00

   

1.00

   

 Amitriptyline (TCA)

34

19,550

2.46

1.75

3.46

<0.001

1.94

1.35

2.78

<0.001

 Dosulepin (TCA)

21

12,120

2.55

1.63

3.97

<0.001

2.19

1.38

3.47

0.001

 Lofepramine (TCA)

12

4750

3.48

1.97

6.14

<0.001

3.09

1.73

5.50

<0.001

 Trazodone (TCA)

12

2320

7.20

4.08

12.71

<0.001

5.41

3.05

9.61

<0.001

 Citalopram (SSRI)

136

93,940

2.07

1.71

2.52

<0.001

2.03

1.66

2.49

<0.001

 Escitalopram (SSRI)

14

13,310

1.47

0.83

2.58

0.185

1.49

0.84

2.63

0.171

 Fluoxetine (SSRI)

111

81,780

1.94

1.55

2.42

<0.001

1.92

1.52

2.41

<0.001

 Paroxetine (SSRI)

26

16,500

2.35

1.50

3.67

<0.001

2.02

1.27

3.23

0.003

 Sertraline (SSRI)

22

18,790

1.71

1.12

2.61

0.013

1.56

1.01

2.42

0.045

 Mirtazapine (other)

17

10,070

2.35

1.47

3.78

<0.001

1.72

1.06

2.80

0.028

 Venlafaxine (other)

36

15,500

3.61

2.59

5.02

<0.001

2.84

1.97

4.08

<0.001

 All other antidepressants

8

4910

2.30

1.16

4.54

0.017

1.67

0.84

3.33

0.143

 Combined antidepressants

13

4220

4.70

2.77

7.98

<0.001

2.71

1.50

4.87

0.001

  1. DDD defined daily dose
  2. aBased on numbers in adjusted analysis. For the first 5 years of follow-up there were 878 cases of epilepsy/seizures in total, and 1126 in total for the whole of follow-up. The total number of cases here is less than 878 due to some being dropped due to missing data on covariates
  3. bPerson years of exposure, based on adjusted analyses
  4. cAdjusted for age, sex, year of diagnosis of depression, severity of depression, deprivation, smoking status, alcohol intake, ethnic group (white/not recorded or non-white), coronary heart disease, diabetes, hypertension, cancer, hypothyroidism, osteoarthritis, asthma/chronic obstructive airways disease, stroke/TIA, rheumatoid arthritis, osteoporosis, liver disease, renal disease, obsessive-compulsive disorder, statins, NSAIDS, aspirin, antihypertensive drugs, anticonvulsants, hypnotics/anxiolytics, oral contraceptives, hormone replacement therapy, antipsychotics, bisphosphonates, anticoagulants
  5. dTotal numbers in the analysis of dosage are less due to missing data on dose
  6. eNumber of events in the no treatment group is less due to some now being included in the time since stopping categories
  7. fThere were no events in the 1–182 days after stopping for combined antidepressants
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BMC Psychiatry

ISSN: 1471-244X

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