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Drug or symptom‐induced depression in men treated with alpha 1 ‐blockers for benign prostatic hyperplasia? A nested case–control study
Author(s) -
Clifford Gary M.,
Farmer Richard D. T.
Publication year - 2002
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.671
Subject(s) - medicine , depression (economics) , cohort , cohort study , incidence (geometry) , population , antidepressant , physics , environmental health , hippocampus , optics , economics , macroeconomics
Purpose Regulatory authorities have raised concern that α 1 ‐blockers, prescribed predominantly for benign prostatic hyperplasia (BPH), may be associated with an increased risk of depression. The aim was to assess the risk of depression with α 1 ‐blockers independently of that associated with symptoms being treated and concurrent illness. Methods Using a study population registered on the UK General Practice Research Database, and taking a prescription for an antidepressant as a proxy for clinical depression, we performed: (a) cohort analyses comparing the incidence of depression in current users of α 1 ‐blockers versus non‐users, and in men with BPH versus those without. (b) A nested case–control analysis looking at the association between depression and α 1 ‐blocker exposure, accounting for the presence of BPH and other illness. Results In the cohort analyses, risk of depression was significantly higher in men with BPH compared to those without (IRR 2.17, 2.12–2.22), but was not significantly different for men exposed to α 1 ‐blockers versus those unexposed when adjusted for the presence of BPH. Cases of depression were more likely to have pre‐existing BPH (crude OR 2.09, 2.02–2.15) than controls. After adjusting for concurrent illness (using number of GP visits as a proxy) and the presence of BPH (adjusted OR 1.38, 1.33–1.43), there was no association with depression for exposure to any α 1 ‐blocker (adjusted OR 1.03, 0.90–1.18). Conclusions This study did not suggest that the prescribing of α 1 ‐blockers increases the risk of being depressed. The association highlighted by spontaneous reporting systems appears to be explained by confounding by concurrent disease. Copyright © 2002 John Wiley & Sons, Ltd.