CASE-CONTROL STUDIES OF CARDIOVASCULAR MEDICATIONS AS RISK-FACTORS FOR CLINICALLY DIAGNOSED DEPRESSIVE-DISORDERS IN A HOSPITALIZED POPULATION

Objective: Certain medications used in cardiovascular therapeutics may contribute to the etiology of substance-induced mood disorders. These medications include digoxin, angiotensin converting enzyme (ACE) inhi bitors, beta-blockers, and calcium channel blockers. The objective of this study was to evaluate associations between these drugs and clinic al diagnoses of depressive disorders in a population of hospitalized p atients. Method: Two case-control studies were conducted. For each stu dy, subjects were selected from a health records data base maintained at the Calgary General Hospital. Selection of subjects in the first st udy was restricted to those receiving a discharge diagnosis of congest ive heart failure and in the second study to subjects receiving a disc harge diagnosis of hypertension. In each of these 2 studies, a single case group was selected along with 2 control groups: a psychiatric con trol group consisting of subjects receiving a psychiatric diagnosis ot her than a depressive disorder and a nonpsychiatric control group rece iving no psychiatric diagnoses. Drug exposures and other variables wer e recorded from a chart review. Results: Exposures to digoxin, beta-bl ockers, and calcium channel blockers were nor associated with depressi ve diagnoses. An association was observed, however, for A CE inhibitor s. An elevated odds ratio (OR) was observed in each case-control study and was stronger in female subjects and subjects over the age of 65. Conclusions: This is the first reported epidemiological evidence of an association between ACE inhibitors and depressive disorders. The desi gn of this study does not permit a determination of whether the observ ed association was causal. Additional studies ave needed.