Association of Depression, Antidepressants With Atrial Fibrillation Risk: A Systemic Review and Meta-Analysis

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2022 Jun 1

PMID 35647056

Authors

Yonghui Fu

Shenghui Feng

Yingxiang Xu

Yuanjian Yang

Haibo Chen

Wenfeng He

Wengen Zhu

Kang Yin

Zhengbiao Xue

Bo Wei

Affiliations

Soon will be listed here.

Abstract

Background: Depression is a possible influence factor for the increased risk of incident atrial fibrillation (AF). Although several investigations have assessed their association, the results are still controversial. Therefore, we conducted a meta-analysis to evaluate the association between depression or using antidepressants and AF.

Methods: We systemically performed the literature retrieval from two electronic databases PubMed and EMBASE until March 2022 to extract relevant data. The hazard ratios (HRs) and odds ratios (OR) from included studies with 95% confidence intervals (CIs) were adjusted into the risk ratio (RR) and pooled by using the random-effects model.

Results: Totally 9 studies about the associations between depression or antidepressants and incident AF risk were included in this meta-analysis. Among them, 5 studies specifically analyzed the impact of antidepressants on the risk of AF. The outcomes of our analysis indicated that depression or depressive symptoms could increase AF risk (RR = 1.15, 95% CI, 1.03-1.27, < 0.01). In addition, the use of antidepressants can also increase AF risk (RR = 1.16, 95% CI, 1.07-1.25, < 0.001). These results remained unchanged when we remove the source of heterogeneity or adjust the analysis model into the fixed-effects model.

Conclusions: Based on existing investigations, both depression and the use of antidepressants are closely related to the increase of incident AF risk.

Citing Articles

Association of healthy lifestyle and the incidence of atrial fibrillation in senior adults: a prospective cohort study.

Deng H, Mei Y, Wu C, Gong C, Lai Z, Huang J BMC Geriatr. 2025; 25(1):160.

PMID: 40055644 PMC: 11889794. DOI: 10.1186/s12877-025-05825-9.

Depression in Cardiac Patients Is a Major Cardiovascular Event Risk Factor: A 12-Month Observational Study.

Podolec J, Kleczynski P, Piechocki M, Okarski M, Lizonczyk K, Szkodon K J Clin Med. 2024; 13(22).

PMID: 39598055 PMC: 11594284. DOI: 10.3390/jcm13226911.

Associations between daytime napping, sleep duration, and depression and 15 cardiovascular diseases: a Mendelian randomization study.

Li Y, Garg P, Wu J Cardiovasc Diagn Ther. 2024; 14(5):771-787.

PMID: 39513145 PMC: 11538837. DOI: 10.21037/cdt-24-313.

Drug-drug-interactions in patients with atrial fibrillation admitted to the emergency department.

Bischof T, Nagele F, Kalkofen M, Blechschmidt M, Domanovits H, Zeitlinger M Front Pharmacol. 2024; 15:1432713.

PMID: 39508037 PMC: 11538323. DOI: 10.3389/fphar.2024.1432713.

Associations of Depression, Antidepressants with Atrial Fibrillation Risk in HFpEF Patients.

Fu Y, Feng S, Gu Z, Liu X, Zhu W, Wei B Rev Cardiovasc Med. 2024; 25(10):370.

PMID: 39484118 PMC: 11522750. DOI: 10.31083/j.rcm2510370.

References

Andrade C . Antidepressants and Atrial Fibrillation: The Importance of Resourceful Statistical Approaches to Address Confounding by Indication. J Clin Psychiatry. 2019; 80(1). DOI: 10.4088/JCP.19f12729. View

Egeberg A, Khalid U, Gislason G, Mallbris L, Skov L, Hansen P . Association between depression and risk of atrial fibrillation and stroke in patients with psoriasis: a Danish nationwide cohort study. Br J Dermatol. 2015; 173(2):471-9. DOI: 10.1111/bjd.13778. View

McCabe P . Psychological distress in patients diagnosed with atrial fibrillation: the state of the science. J Cardiovasc Nurs. 2009; 25(1):40-51. DOI: 10.1097/JCN.0b013e3181b7be36. View

Yusuf S, Al-Saady N, Camm A . 5-hydroxytryptamine and atrial fibrillation: how significant is this piece in the puzzle?. J Cardiovasc Electrophysiol. 2003; 14(2):209-14. View

Aviles R, Martin D, Apperson-Hansen C, Houghtaling P, Rautaharju P, Kronmal R . Inflammation as a risk factor for atrial fibrillation. Circulation. 2003; 108(24):3006-10. DOI: 10.1161/01.CIR.0000103131.70301.4F. View

Hart R, Palacio S, Pearce L . Atrial fibrillation, stroke, and acute antithrombotic therapy: analysis of randomized clinical trials. Stroke. 2002; 33(11):2722-7. DOI: 10.1161/01.str.0000035735.49388.4a. View

Garg P, ONeal W, Diez-Roux A, Alonso A, Soliman E, Heckbert S . Negative Affect and Risk of Atrial Fibrillation: MESA. J Am Heart Assoc. 2018; 8(1):e010603. PMC: 6405728. DOI: 10.1161/JAHA.118.010603. View

Engelmann M, Svendsen J . Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J. 2005; 26(20):2083-92. DOI: 10.1093/eurheartj/ehi350. View

Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim E . A meta-analysis of cytokines in major depression. Biol Psychiatry. 2009; 67(5):446-57. DOI: 10.1016/j.biopsych.2009.09.033. View

10.

Stewart S, Hart C, Hole D, McMurray J . A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med. 2002; 113(5):359-64. DOI: 10.1016/s0002-9343(02)01236-6. View

11.

Feng T, Malmo V, Laugsand L, Strand L, Gustad L, Ellekjaer H . Symptoms of anxiety and depression and risk of atrial fibrillation-The HUNT study. Int J Cardiol. 2019; 306:95-100. DOI: 10.1016/j.ijcard.2019.11.107. View

12.

Shi S, Liu T, Liang J, Hu D, Yang B . Depression and Risk of Sudden Cardiac Death and Arrhythmias: A Meta-Analysis. Psychosom Med. 2016; 79(2):153-161. DOI: 10.1097/PSY.0000000000000382. View

13.

Mathew A, Hogarth L, Leventhal A, Cook J, Hitsman B . Cigarette smoking and depression comorbidity: systematic review and proposed theoretical model. Addiction. 2016; 112(3):401-412. PMC: 5296249. DOI: 10.1111/add.13604. View

14.

Miyasaka Y, Barnes M, Bailey K, Cha S, Gersh B, Seward J . Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. J Am Coll Cardiol. 2007; 49(9):986-92. DOI: 10.1016/j.jacc.2006.10.062. View

15.

Leonard B . The immune system, depression and the action of antidepressants. Prog Neuropsychopharmacol Biol Psychiatry. 2001; 25(4):767-80. DOI: 10.1016/s0278-5846(01)00155-5. View

16.

Rewiuk K, Wizner B, Klich-Raczka A, Wiecek A, Mossakowska M, Chudek J . Atrial fibrillation independently linked with depression in community-dwelling older population. Results from the nationwide PolSenior project. Exp Gerontol. 2018; 112:88-91. DOI: 10.1016/j.exger.2018.09.006. View

17.

Coupland C, Hill T, Morriss R, Moore M, Arthur A, Hippisley-Cox J . Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database. BMJ. 2016; 352:i1350. PMC: 4804126. DOI: 10.1136/bmj.i1350. View

18.

Lip G, Tse H, Lane D . Atrial fibrillation. Lancet. 2011; 379(9816):648-61. DOI: 10.1016/S0140-6736(11)61514-6. View

19.

Fu Y, He W, Ma J, Wei B . Relationship between psychological factors and atrial fibrillation: A meta-analysis and systematic review. Medicine (Baltimore). 2020; 99(16):e19615. PMC: 7220243. DOI: 10.1097/MD.0000000000019615. View

20.

Garg P, Claxton J, Soliman E, Chen L, Lewis T, Mosley T . Associations of anger, vital exhaustion, anti-depressant use, and poor social ties with incident atrial fibrillation: The Atherosclerosis Risk in Communities Study. Eur J Prev Cardiol. 2021; 28(6):633-640. PMC: 8981832. DOI: 10.1177/2047487319897163. View