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Friday March 20 NEW YORK (Reuters) -- Exposure to certain tricyclic antidepressant drugs may increase the risk for a lung disease called idiopathic pulmonary fibrosis (IPF), according to a report published by the American Lung Association. "Such exposures may be responsible for approximately 10% of cases of IPF in our local (study) population," say pulmonary researchers at University Hospital in Nottingham, England. Smoking, exposure to dust -- and in rare cases, certain medications -- can increase the risk of pulmonary fibrosis, a lung disease characterized by inflammation and scarring that leads to stiffening of lung tissue over time. However, some cases are idiopathic, that is, the cause is unknown. Breathlessness and dry cough are among the first symptoms of the disease, which affects between 3 to 5 out of every 100,000 people. The study, published in the current issue of the American Journal of Respiratory and Critical Care Medicine, focused on the lifetime medication use of 387 individuals averaging 65 years of age. These participants were divided into a "case" group of 141 individuals suffering from IPF, and 246 healthy "control" individuals. The researchers discovered that "significantly more case subjects had been prescribed antidepressants than control subjects." Most of these at-risk antidepressant users had taken at least one of three drugs belonging to the family of tricyclics. Specifically, the researchers found that users of the drug imipramine had nearly five times the likelihood of contracting IPF, those prescribed mianserin had over triple the risk, while users of a third drug, dothiepin, were more than twice as likely to contract the condition, compared with controls. Lead author Dr. Richard Hubbard says that "although these findings need confirmation in other studies, it seems sensible to suggest that any patient with IPF who is taking tricyclic antidepressants, particularly imipramine, should discuss with his or her doctor having this antidepressant changed to another drug." Hubbard adds that "it seems sensible to avoid starting tricyclics in patients with IPF, particularly now that there are a lot of other effective newer antidepressants available." However, he notes that treatment decisions must be made on a case-by-case basis between patients and their doctors, since "depression can be life-threatening, and some cases respond only to tricyclic antidepressants." The new finding needs to be confirmed by other studies, according to Dr. Gary Hunninghake, director of the pulmonary division at the University of Iowa Hospitals in Iowa City. "For now, I would advise that patients taking tricyclic antidepressants not stop their medications," said Hunninghake in a statement released by the American Lung Association. "They may want to discuss this with their personal physician." SOURCE: American Journal of Respiratory and Critical Care Medicine (1998;157:743-747)