There’s an article in Science Daily (April 29, 2013) titled “Antidepressants Linked with Increased Risks After Surgery,” which I found courtesy of Monica on Twitter. You can see it here. The article is a report of a study published in JAMA Internal Medicine. You can see an abstract of the study here.
The study was conducted by Andrew Auerbach MD et al, and involved examining the records of 530,416 patients who had undergone major surgery between January 2006 and December 2008 at 375 US hospitals.
The researchers found that patients receiving SSRI’s had higher odds of in-hospital mortality (1.2), bleeding (1.09), and readmission at 30 days (1.22) What this means with regards to post-surgery mortality, for instance, is that the odds of an SSRI recipient dying was 1.20 times greater than the odds of a non-SSRI recipient dying.
This study was an historical review and not a randomized controlled trial, so we can’t conclude that the SSRI’s definitely caused the adverse events. It could be argued, for instance, that the individuals who were prescribed the SSRI’s were in poorer shape to being with. However, the authors did conduct a retrospective matched pairs analysis of the data. This involved comparing those patients who received the drugs with matched controls who did not. Pairs were matched for age, gender, medical status, and depression. In this analysis, the administration of SSRI’s was still associated with increased risk, suggesting that a causal link is likely.
This result is of particular concern in that people who are chronically ill are often pressured to take antidepressants. I’ve had some personal experience with this. In August 2001, after a life-time of more or less perfect health, I lost my kidneys. In the space of a month, I went from about the 99th percentile health wise to about the 1st. I was somewhat despondent.
I was dialyzing at a large dialysis unit (about 60 chairs), and one of the nephrologists put a great deal of pressure on me to take an antidepressant, even though I had never asked for help with depression and had never even thought of, let alone mentioned, suicide. I consistently refused the drugs. Our final conversation on the matter went something like this:
Nephrologist: I think you should take the antidepressant.
Me: No thank you.
Nephrologist: But you are depressed.
Me: Anyone in my circumstances who is not depressed hasn’t grasped the reality of his predicament.
Nephrologist: But it would help you feel better.
Me. I don’t want to talk about it any more.
He then turned to my wife, Nancy, who was in the room, and tried to enlist her aid in persuading me to take the drugs.
Nancy replied: Is there something about Phil’s response that you don’t understand?
Nothing further was said, but we heard later that about 80% of the patients in that unit were taking antidepressants. That’s 60 chairs, 3 shifts Monday, Wednesday, Friday, and 3 shifts Tuesday, Thursday, Saturday – about 360 patients x 80% = 288. For the record, I came through the down times using the time-honored methods of talking to family and the occasional good cry, and staying as busy as my condition permitted.
In another treatment unit, about a year later, I received similar pressure from a different nephrologist. I was an inpatient at the time, and he was so persistent that eventually I had to order him out of my room.
In fairness, it needs to be said that in the twelve years I’ve been sick, I’ve worked with about 20 different nephrologists, and these were the only two who subjected me to this kind of pressure. But although these drug pushers may be a minority, they have a disproportionate effect. Nephrologists tend to work in large practices because they have to provide 24/7 care. So over, say, a six month period, every doctor sees pretty much every patient. The drug pushers use this opportunity to prescribe the antidepressants, and the other doctors are generally reluctant to reverse this decision. So the prescriptions stay in place by inertia.
One of the realities of life is that sick people like to talk about their illnesses, and over the years I’ve met and swapped stories with hundreds of fellow sufferers – not only in nephrology, but in other specialties as well. One of the questions I usually ask is: did they want you to take antidepressants? And it is truly shocking how often the answer is yes.
A major part of the rationale behind this drug pushing is that the antidepressants will help the body to heal generally. This has always seemed like pharma spiel to me, and the Auerbach study suggests, not only that the rationale is false, but that the opposite is more likely to be the case.
Incidentally, there are no records of financial ties between any of the authors and pharma (Dollars for Docs).