Tricyclic antidepressants updated on 07-01-2025

Postpartum hemorrhage

R analysis
id Study   Lib. in paper Exposition period    Study type 
 Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S18445
R78333		 Lee (Controls exposed to SSRI), 2025 Postpartum haemorrhage during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: TCA only 0.62 [0.39;0.97] C
excluded (control group) 		24/613   91/1,465 115 613
ref
S18410
R77734		 Lee (Controls unexposed, general pop), 2025 Postpartum haemorrhage during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: TCA only 0.93 [0.61;1.40] 24/613   19,755/463,440 19,779 613
ref
S11668
R42776		 Källen, 2013 Haemorrhage around delivery (O46, O67 or O72) 2nd and/or 3rd trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.24 [0.88;1.76] 35/394   -/- - 394
ref
S11390
R41887		 Palmsten b, 2013 Postpartum hemorrhage (ICD-9 code for 666.x) late pregnancy retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: TCA only Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified 1.77 [0.90;3.47] -/175   1,896/69,044 - 175
ref
Total 3 studies 1.19 [0.88;1.60] 19,779 1,182
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

StudyTE95% CIn casesn exposedweightROBABCDEF Lee (Controls unexposed, general pop), 2025Lee, 2025 1 0.93[0.61; 1.40]19,77961337%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Källen, 2013Källen, 2013 1.24[0.88; 1.76]-39446%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Palmsten b, 2013Palmsten b, 2013 1.77[0.90; 3.47]-17517%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Total (3 studies) I2 = 27% 1.19[0.88; 1.60]19,7791,1820.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, general pop;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.19[0.88; 1.60]19,7791,18227%NALee (Controls unexposed, general pop), 2025 Källen, 2013 Palmsten b, 2013 3 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.10[0.83; 1.45]19,7791,0078%NALee (Controls unexposed, general pop), 2025 Källen, 2013 2 unexposed, sickunexposed, sick 1.77[0.90; 3.48]-175 -NAPalmsten b, 2013 1 Tags Adjustment   - Yes  - Yes 1.19[0.88; 1.60]19,7791,18227%NALee (Controls unexposed, general pop), 2025 Källen, 2013 Palmsten b, 2013 3 Monotherapy   - no or not specified  - no or not specified 1.24[0.88; 1.75]-394 -NAKällen, 2013 1   - TCA only  - TCA only 1.21[0.65; 2.25]19,77978861%NALee (Controls unexposed, general pop), 2025 Palmsten b, 2013 2 Unexposed sick   - old history of illness/treatment (> ...  - old history of illness/treatment (> 12 months before pregnancy) or not specified 1.77[0.90; 3.48]-175 -NAPalmsten b, 2013 1 All studiesAll studies 1.19[0.88; 1.60]19,7791,18227%NALee (Controls unexposed, general pop), 2025 Källen, 2013 Palmsten b, 2013 30.25.01.0

Publication bias and p-hacking diagnosis

funnel plot

Funnel plot not drawn. Less than 3 points.

Asymetry test p-value = NaN (by Egger's regression)

not enought points

p values plot

Funnel plot not drawn. Less than 3 points.

Sub-groups analysis using all included studies

excluded 18445

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.10[0.83; 1.45]19,8051,0078%NALee (Controls unexposed, general pop), 2025 Källen, 2013 2 unexposed, sick controlsunexposed, sick controls 1.77[0.90; 3.48]1,887175 -NAPalmsten b, 2013 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.62[0.39; 0.97]115613 -NALee (Controls exposed to SSRI), 2025 10.510.01.0