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Association between antidepressants with pneumonia and exacerbation in patients with COPD: a self-controlled case series (SCCS)
  1. Rayan A Siraj1,2,
  2. Charlotte E Bolton2,
  3. Tricia M McKeever3
  1. 1Department of Respiratory Care, King Faisal University, Al-Ahasa, Saudi Arabia
  2. 2Respiratory Medicine, NIHR Nottingham Biomedical Research Centre Respiratory Theme, University of Nottingham, Nottingham, UK
  3. 3NIHR Nottingham Biomedical Research Centre Respiratory Theme, School of Medince, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Tricia M McKeever, University of Nottingham Division of Epidemiology and Public Health, Nottingham, Nottingham, UK; tricia.mckeever{at}


Objective To assess whether antidepressant prescriptions are associated with an increased risk of pneumonia and chronic obstructive pulmonary disease (COPD) exacerbation.

Methods A self-controlled case series was performed to investigate the rates of pneumonia and COPD exacerbation during periods of being exposed to antidepressants compared with non-exposed periods. Patients with COPD with pneumonia or COPD exacerbation and at least one prescription of antidepressant were ascertained from The Health Improvement Network in the UK. Incidence rate ratios (IRR) and 95% CI were calculated for both outcomes.

Results Of 31 253 patients with COPD with at least one antidepressant prescription, 1969 patients had pneumonia and 18 483 had a COPD exacerbation. The 90-day risk period following antidepressant prescription was associated with a 79% increased risk of pneumonia (age-adjusted IRR 1.79, 95% CI 1.54 to 2.07). These associations then disappeared once antidepressants were discontinued. There was a 16% (age-adjusted IRR 1.16, 95% CI 1.13 to 1.20) increased risk of COPD exacerbation within the 90 days following antidepressant prescription. This risk persisted and slightly increased in the remainder period ((age-adjusted IRR 1.38, 95% CI 1.34 to 1.41), but diminished after patients discounted the treatment.

Conclusion Antidepressants were associated with an increased risk of both pneumonia and exacerbation in patients with COPD, with the risks diminished on stopping the treatment. These findings suggest a close monitoring of antidepressant prescription side effects and consideration of non-pharmacological interventions.

  • COPD Exacerbations
  • COPD epidemiology

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Contributors Conceptualisation; RAS, CEB and TMM: data curation; RAS: formal analysis; RAS: investigation; RAS, CEB and TMM: methodology; RAS, CEB and TMM: project administration; RAS, CEB and TMM: resources; RAS, CEB and TMM: supervision; CEB and TMM: validation; RAS, CEB and TMM: writing of the original draft; all authors contributed to the writing, review and editing. RAS is the guarantor of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors have completed the International Committee of Medical Journal Editors (ICMJE) Form for Disclosure of Potential Conflicts of Interest (available on request from the corresponding author) and declare that the following: CEB reports grants from BLF Early COPD Study—various pharma, grants from Pfizer, grants from GSK, other from Chiesi, outside the submitted work; and no financial relationship with any organisation that might have an interest in the submitted work in the previous three years, no other relationship or activity that could appear to have influenced the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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