Safety of Prescribing of SSRIs/SNRIs to Menopausal Women with Common Mental Health Diagnoses

Abstract

This project aimed to: 1) Describe the prescribing of menopausal hormone therapy (MHT) and selective serotonin reuptake inhibitors (SSRIs)/Selective norepinephrine reuptake inhibitors (SNRIs) to menopausal women with common mental health diagnoses (CMHDs); and 2) Examine the association between SSRIs/SNRIs and the risk of osteoporotic fractures (OFs), myocardial infarction, and stroke among women with CMHDs. The project consisted of a literature review and five observational studies using IMRD-UK as a data source. First, I completed two descriptive studies on the incidence of CMHDs and the prescribing of MHT, SSRIs/SNRIs and other psychotropic medicines to women aged 45 and older. Then, a cohort study and self-controlled case series were conducted to assess the risk of OFs associated with prescribing SSRIs/SNRIs to menopausal women with CMHDs. Finally, the risk of myocardial infarction and stroke associated with the prescribing of SSRIs/SNRIs to menopausal women was assessed in a cohort study. Compared to men, women aged 45 and older had higher rates of CMHDs in 2021, with incidence rate ratios of 1.84 (95% CI: 1.72–1.97) and 1.44 (95% CI: 1.35–1.53) for anxiety and depressive disorders, respectively. SSRIs/SNRIs were the most prescribed medications to both men and women with CMHDs (36.59%). There was a 6.67% increase in new prescribing of MHT to menopausal women with CMHDs between 2010 and 2021. There was strong evidence that the prescribing of SSRIs/SNRIs to women with CMHD was associated with an increased risk of OFs (HR=1.32, 95% CI: 1.29–1.34) and increased risk of stroke (HR=1.12, 95% CI: 1.08–1.16), but not an increased risk of myocardial infarction (HR=0.91, 95% CI: 0.87–0.95). In conclusion, care for women experiencing CMHDs during and after MT should be carefully considered. Treatment with SSRIs/SNRIs needs to be evaluated regularly as it may pose an additive risk of OFs and stroke.