Tricyclic antidepressants updated on 07-01-2025

Respiratory system anomalies

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.
S18161
R76382		 Chan (Controls exposed to SSRIs), 2024 Respiratory system malformations 1st trimester retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: TCA only 0.85 [0.18;4.10] C
excluded (control group) 		2/322   7/956 9 322
ref
S18156
R76336		 Chan (Controls unexposed, general pop), 2024 Respiratory system malformations 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) excluded Adjustment: Yes Monotherapy: TCA only 1.87 [0.37;9.54]
excluded (control group) 		2/322   1,205/462,377 1,207 322
ref
S18157
R76347		 Chan (Controls unexposed, sick), 2024 Respiratory system malformations 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: No Monotherapy: TCA only Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified 0.79 [0.05;13.19] C 0/181   15/4,413 15 181
ref
S11052
R40982		 Bérard (Controls unexposed, sick), 2017 Respiratory system malformations 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: TCA only Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 0.90 [0.22;3.61] -/382   -/14,847 - 382
ref
S10937
R40714		 Ban (Controls exposed to SSRIs), 2014 Respiratory system malformations 1st trimester retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: TCA only 1.58 [0.48;5.26] C
excluded (control group) 		4/2,428   8/7,683 12 2,428
ref
S10938
R40730		 Ban (Controls unexposed, disease free), 2014 Respiratory system malformations 1st trimester retrospective cohort (claims database) unexposed, disease free excluded Adjustment: Yes Monotherapy: TCA only 2.50 [0.93;6.69]
excluded (control group) 		4/2,428   205/325,294 209 2,428
ref
S10939
R40752		 Ban (Controls unexposed, sick), 2014 Respiratory system malformations 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: No Monotherapy: TCA only Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 4.43 [1.19;16.51] C 4/2,428   5/13,432 9 2,428
ref
S10930
R40603		 Davis, 2007 Congenital anomalies of respiratory system 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.09 [0.15;7.72] 1/167   256/49,669 257 167
ref
Total 4 studies 1.69 [0.70;4.07] 281 3,158
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 Chan (Controls unexposed, sick), 2024Chan, 2024 1 0.79[0.05; 13.19]151819%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Bérard (Controls unexposed, sick), 2017Bérard, 2017 2 0.90[0.22; 3.61]-38234%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Ban (Controls unexposed, sick), 2014Ban, 2014 3 4.43[1.19; 16.51]92,42838%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Davis, 2007Davis, 2007 1.09[0.15; 7.72]25716718%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 9% 1.69[0.70; 4.07]2813,1580.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick; 2: Controls unexposed, sick; 3: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.69[0.70; 4.07]2813,1589%NAChan (Controls unexposed, sick), 2024 Bérard (Controls unexposed, sick), 2017 Ban (Controls unexposed, sick), 2014 Davis, 2007 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.09[0.15; 7.82]257167 -NADavis, 2007 1 unexposed, sickunexposed, sick 1.78[0.54; 5.84]242,99135%NAChan (Controls unexposed, sick), 2024 Bérard (Controls unexposed, sick), 2017 Ban (Controls unexposed, sick), 2014 3 Tags Adjustment   - No  - No 2.40[0.85; 6.79]2812,7763%NAChan (Controls unexposed, sick), 2024 Ban (Controls unexposed, sick), 2014 Davis, 2007 3   - Yes  - Yes 0.90[0.22; 3.65]-382 -NABérard (Controls unexposed, sick), 2017 1 Monotherapy   - no or not specified  - no or not specified 1.09[0.15; 7.82]257167 -NADavis, 2007 1   - TCA only  - TCA only 1.78[0.54; 5.84]242,99135%NAChan (Controls unexposed, sick), 2024 Bérard (Controls unexposed, sick), 2017 Ban (Controls unexposed, sick), 2014 3 Unexposed sick   - intermediate history of illness/tre ...  - intermediate history of illness/treatment (3-12 months before pregnancy) 2.03[0.43; 9.70]92,81062%NABérard (Controls unexposed, sick), 2017 Ban (Controls unexposed, sick), 2014 2   - old history of illness/treatment (> ...  - old history of illness/treatment (> 12 months before pregnancy) or not specified 0.79[0.05; 13.19]15181 -NAChan (Controls unexposed, sick), 2024 1 All studiesAll studies 1.69[0.70; 4.07]2813,1589%NAChan (Controls unexposed, sick), 2024 Bérard (Controls unexposed, sick), 2017 Ban (Controls unexposed, sick), 2014 Davis, 2007 40.210.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.43.91.7270.000Chan (Controls unexposed, sick), 2024Bérard (Controls unexposed, sick), 2017Ban (Controls unexposed, sick), 2014Davis, 2007

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

not enought points

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 10937, 10938, 18161, 18156

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 2.06[0.95; 4.47]1,6732,9170%NAChan (Controls unexposed, general pop), 2024 Ban (Controls unexposed, disease free), 2014 Davis, 2007 3 unexposed, sick controlsunexposed, sick controls 1.78[0.54; 5.84]242,99135%NAChan (Controls unexposed, sick), 2024 Bérard (Controls unexposed, sick), 2017 Ban (Controls unexposed, sick), 2014 3 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.26[0.48; 3.27]212,7500%NAChan (Controls exposed to SSRIs), 2024 Ban (Controls exposed to SSRIs), 2014 20.510.01.0