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Selective Serotonin Reuptake Inhibitors and the Risk of Acute Pancreatitis: A Swedish Population-Based Case-Control Study

Ljung, Rickard MD, PhD*; Rück, Christian MD, PhD; Mattsson, Fredrik BSc*; Bexelius, Tomas Sjöberg MD, PhD*; Lagergren, Jesper MD, PhD*‡; Lindblad, Mats MD, PhD

Journal of Clinical Psychopharmacology: June 2012 - Volume 32 - Issue 3 - p 336–340
doi: 10.1097/JCP.0b013e318253d71a
Original Contributions

Abstract: Case reports have indicated an increased risk of acute pancreatitis during use of selective serotonin reuptake inhibitors (SSRIs), an association not found in a few epidemiological studies. We studied the use of SSRI in relation to risk of acute pancreatitis in a population-based case-control study of people aged 40 to 84 years between 2006 and 2008 in Sweden. The Patient Register was used to identify 6161 cases of first-episode acute pancreatitis. The Register of the Total Population was used to randomly select 61,637 control subjects from the general population using frequency-based density sampling, matched for age, sex, and calendar year. Use of SSRI was defined as “current,” “recent,” “past,” or “former” if the drug had been dispensed 1 to 114 days, 115 to 180 days, 181 to 365 days, or 1 to 3.5 years before a given index date, respectively. Logistic regression with adjustment for potential confounding factors was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs). The OR for acute pancreatitis, adjusted for matching variables, was increased among present users of SSRI (OR, 1.5; 95% CI, 1.4–1.7). After adjusting for diseases or medications related to alcohol overconsumption, tobacco smoking, diabetes, ischemic heart disease, obesity, and severe pain together with educational level and marital status, the corresponding OR was 1.1 (95% CI, 1.0–1.3). After adjusting for the number of distinct medications, a proxy for comorbidity, the corresponding OR was 1.0 (95% CI, 0.9–1.1). The OR for antidepressant use other than SSRI showed a similar pattern. In conclusion, no increased risk of acute pancreatitis remained among users of SSRI after adjusting for confounding factors.

From the *Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, and †Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; ‡Division of Cancer Studies, King’s College, London, United Kingdom; and §Section of Upper Gastrointestinal Surgery, Gastrocenter, Karolinska University Hospital, Stockholm, Sweden.

Received May 18, 2011; accepted after revision November 18, 2011.

Reprints: Rickard Ljung, MD, PhD, Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Norra Stationsgatan 67, 2nd Floor, Karolinska Institutet, SE-171 76 Stockholm, Sweden (e-mail: rickard.ljung@ki.se).

Dr Ljung was supported by a grant from the Astrid and David Hagelén Foundation. The study was supported by grants from the Swedish Research Council (SIMSAM) and a Regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet, and the Bengt Ihre Foundation. The study sponsors had no involvement in the analysis or in the article.

© 2012 Lippincott Williams & Wilkins, Inc.