This article is more than 5 years old. Information may no longer be current.
Greater antidepressant use lowers mortality risk for adults with diabetes plus depression
Click Here to Manage Email Alerts
An analysis of Korean health insurance data suggests that adults with diabetes and comorbid depression were less likely to die over nearly 9 years of follow-up when prescribed an antidepressant, with both dose-specific and class-specific effects observed, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
“The incidence of major depressive disorder among individuals with diabetes is significantly greater than the general population,” Vincent Chin-Hung Chen, MD, PhD, professor at Chang Gung University School of Medicine and staff psychiatrist and physician scientist in the department of psychiatry at Chiayi Chang Gung Hospital, Taiwan, told Endocrine Today. “Diabetes and depression each independently contribute to elevated total mortality. This first nationwide, population-based study showed antidepressant use was associated with significantly reduced mortality by 35% among patients with diabetes and comorbid depression.”
In a retrospective, population-based cohort study, Chen and colleagues used data from the National Health Insurance Research Database in Taiwan to identify 53,412 cases of newly diagnosed diabetes with comorbid depression since 2000 (44.75% men; 49.13% aged 45 to 64 years; 50,532 antidepressant users). Researchers followed patients through 2013, assessing mortality and the association between mortality and antidepressant use, adjusted for cumulative dosing. Antidepressant use was also analyzed by class, and users were stratified by cumulative dose exposure into three groups, with a mean follow-up across groups ranging from 9.2 to 9.9 years.
Researchers found that the incidence rate of death events ranged from 1,113.7 per 100,000 person-years in the highest daily-dose group to 1,963.7 per 100,000 person-years in the lowest dose group.
Using a time-dependent Cox regression model, the researchers found that as total cumulative antidepressant dose increased, total mortality decreased. In a model adjusted for sex, age, income, comorbidities and urbanization, patients in the highest antidepressant dose group were 35% less likely to die during follow-up when compared with patients in the lowest antidepressant dose group (adjusted HR = 0.65; 95% CI, 0.59-0.71).
Researchers also observed differences in mortality risk in analyses stratified by antidepressant type, with the greatest mortality risk reduction observed in patients prescribed norepinephrine-dopamine reuptake inhibitors (HR = 0.2; 95% CI, 0.07-0.63), followed by trazodone (HR = 0.52; 95% CI, 0.29-0.91), serotonin-norepinephrine reuptake inhibitors (HR = 0.58; 95% CI, 0.44-0.78), mirtazapine (HR = 0.6; 95% CI, 0.45-0.82), selective serotonin reuptake inhibitors (HR = 0.63; 95% CI, 0.56-0.71) and tricyclic/tetracyclic antidepressants (HR = 0.73; 95% CI, 0.54-0.97).
In contrast, researchers found that reversible monoamine oxidase inhibitor antidepressants were associated with an increase, rather than decrease, in total mortality (HR = 1.48; 95% CI, 1.09-1.99).
“This data provides further rationale for the screening and treating of depression in persons who have diabetes,” Chen said. “For patients with diabetes and comorbid depression, doctors can take into account the necessity to prescribe antidepressants.”
Chen said further analysis of which cause-specific mortality can be reduced by antidepressants is warranted, and the mechanism behind why the death rate can be reduced needs to be explored. – by Regina Schaffer
For more information:
Vincent Chin-Hung Chen, MD, PhD, can be reached at Chang Gung Medical University, No. 6 West Chia-Pu Road, Putzu, Chiayi County 613, Taiwan; email: hjcch@yahoo.com.tw.
Disclosures: The authors report no relevant financial disclosures.
Collapse
Chen HM, et al. J Clin Endocrinol Metab. 2019;doi:10.1210/jc.2018-02362.
Click Here to Manage Email Alerts