Serotonergic Antidepressant Use and Morbidity and Mortality Among Older Adults with COPD

Vozoris NT, Wang X, Austin PC, et al. Eur Respir J  2018 Jun 26. [Epub ahead of print] [CrossRef]

The authors 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, however, a recent publication in the SWJPCC found no relationship between depression scores and 30-day readmission for exacerbation of COPD.