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–noradrenaline reuptake inhibitor (SNRI) drug use and respiratory-related morbidity and mortality among older adults with chronic obstructive pulmonary disease (COPD). This was a retrospective population-based cohort study using heath administrative data from Ontario, Canada. Individuals aged 66 years, 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 minimise potential confounding. Among propensity score matched community-dwelling individuals, new SSRI/SNRI users compared to non-users had significantly higher rates of hospitalisation for COPD or pneumonia (hazard ratio (HR) 1.15, 95% CI 1.05–1.25), emergency room 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). In addition, respiratory-specific and all-cause mortality rates were 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.