Are antidepressants an independant risk factor for ischaemic heart disease?
• Peter Cansfield, Specialist Registrar in Public Health Leicestershire Health Authority Julia Hippisley-Cox et al claim they have found good evidence for an association between dosulepin (Dothiepin) and subsequent ischaemic heart disease. However this interpretation of their results appears unwarranted. As they state, depression is a known independent risk factor for ischaemic heart disease. Their best estimate for the increased risk due to depression alone is their adjusted odds ratio of 1.41. Adjusted odds ratios for most of their different groupings of antidepressants are of this order and all include the value 1.41 well within their confidence intervals. Moreover where antidepressants are more likely to have been prescribed for reasons other than depression (‘amitritptyline ever’ and ‘other antidepressant’ categories) the best estimates of adjusted odds ratios fall much closer to 1.0. Historically amitriptyline and dosulepin (Dothiepin) have greater cumulative use and therefore re
