The relationship between antihypertensive medications and mood disorders: analysis of linked healthcare data for 1.8 million patients

Shaw, R. J. , Mackay, D. , Pell, J. P. , Padmanabhan, S. , Bailey, D. S. and Smith, D. J. (2021) The relationship between antihypertensive medications and mood disorders: analysis of linked healthcare data for 1.8 million patients. Psychological Medicine, 51(7), pp. 1183-1191. (doi: 10.1017/S0033291719004094) (PMID:31973782)

Abstract

Background: Recent work suggests that antihypertensive medications may be useful as repurposed treatments for mood disorders. Using large-scale linked healthcare data we investigated whether certain classes of antihypertensive, such as angiotensin antagonists (AAs) and calcium channel blockers, were associated with reduced risk of new-onset major depressive disorder (MDD) or bipolar disorder (BD). Method: Two cohorts of patients treated with antihypertensives were identified from Scottish prescribing (2009–2016) and hospital admission (1981–2016) records. Eligibility for cohort membership was determined by a receipt of a minimum of four prescriptions for antihypertensives within a 12-month window. One treatment cohort (n = 538 730) included patients with no previous history of mood disorder, whereas the other (n = 262 278) included those who did. Both cohorts were matched by age, sex and area deprivation to untreated comparators. Associations between antihypertensive treatment and new-onset MDD or bipolar episodes were investigated using Cox regression. Results: For patients without a history of mood disorder, antihypertensives were associated with increased risk of new-onset MDD. For AA monotherapy, the hazard ratio (HR) for new-onset MDD was 1.17 (95% CI 1.04–1.31). Beta blockers' association was stronger (HR 2.68; 95% CI 2.45–2.92), possibly indicating pre-existing anxiety. Some classes of antihypertensive were associated with protection against BD, particularly AAs (HR 0.46; 95% CI 0.30–0.70). For patients with a past history of mood disorders, all classes of antihypertensives were associated with increased risk of future episodes of MDD. Conclusions: There was no evidence that antihypertensive medications prevented new episodes of MDD but AAs may represent a novel treatment avenue for BD.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Smith, Professor Daniel and Mackay, Professor Daniel and Shaw, Dr Richard and Padmanabhan, Professor Sandosh and Pell, Professor Jill
• Authors: Shaw, R. J., Mackay, D., Pell, J. P., Padmanabhan, S., Bailey, D. S., and Smith, D. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Psychological Medicine
• Publisher: Cambridge University Press
• ISSN: 0033-2917
• ISSN (Online): 1469-8978
• Published Online: 24 January 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in Psychological Medicine 51(7): 1183-1191
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
302957		Mental Health Data Pathfinder	Daniel Smith	Medical Research Council (MRC)	MC_PC_17217	HW - Mental Health and Wellbeing
173162		Antihypertensives as repurposed treatments for mood disorders: a Scottish national linkage and UK Biobank investigation	Daniel Smith	Chief Scientist Office (CSO)	TCS/16/6	HW - Mental Health and Wellbeing