Screening for and treating depression in patients with diabetes may be associated with a lower mortality risk, as most antidepressants are associated with reduced mortality in these patients, according to study results published in The Journal of Clinical Endocrinology & Metabolism.
Major depressive disorder is much more common in individuals with diabetes compared with the general population. As diabetes and depression each contribute to increased mortality risk, treatment with antidepressants may have significant effect on mortality in patients with both conditions. The goal of this study was to assess the effect of antidepressants on mortality in individuals with diabetes and depression.
The retrospective cohort study enrolled patients from the Taiwan National Health Insurance Research Database with ≥1 psychiatric admission or 3 psychiatric outpatient visits. The primary outcome was the association between mortality and treatment with antidepressants. The data were also analyzed after adjustment for multiple confounders, including the total antidepressant dose exposure (cumulative defined daily dose, or cDDD).
Of 53,412 patients with newly diagnosed diabetes and depression, 50,532 were treated with antidepressants and 2880 were not using these medications.
The researchers divided the participants into 3 subgroups, according to cDDD: <28 cDDD (10,317 patients), 28 to 83 cDDD (9771 patients), and 84 to 364 cDDD (33,324 patients). The incidence rate of death events was 1113.7 per 100,000 person-years in highest dose group, 1515.4 per 100,000 person years in middle dose group, and 1963.7 per 100,000 person-years in lowest dose group (Log-rank test, P <.001).
As total cumulative dose increased, the risk for mortality decreased: with cDDD >28, the adjusted hazard ratio (HR) for mortality was 0.91 (95% CI, 0.83-1.00) and with the highest cDDD (≥84), the adjusted HR for mortality was 0.65 (95% CI, 0.59-0.71). Mortality risk was greater in males compared with females (adjusted HR, 1.71; 95% CI, 1.63-1.80).
As for the effect of different antidepressant classes/agents on mortality risk, there were some differences found between antidepressants categories with cDDD ≥84. Hazard ratios differed between selective serotonin reuptake inhibitors (HR, 0.63; 95% CI, 0.56-0.71), serotonin-norepinephrine reuptake inhibitors (HR, 0.58; 95% CI, 0.44-0.78), norepinephrine-dopamine reuptake inhibitors (HR, 0.20; 95% CI 0.07-0.63), mirtazapine (HR, 0.60; 95% CI, 0.45-0.82), tricyclic/tetracyclic antidepressants (HR, 0.73; 95% CI, 0.54-0.97), and trazodone (HR, 0.52; 95% CI, 0.29-0.91). Conversely, treatment with reversible inhibitor of monoamine oxidase A was associated with increased mortality risk (HR, 1.48; 95% CI, 1.09-1.99).
The study had several limitations, including the inherent limitations of a database study, no data regarding the specific cause of death, and no adjustment for comorbid conditions (such as smoking and obesity) that may be confounding factors. Furthermore, the findings may not be generalizable to patients with diabetes outside of Taiwan.
“[T]his is the first large population-based cohort study to identify an inverse association between [antidepressant] use and mortality among individuals diagnosed with [diabetes] and comorbid depression,” concluded the researchers.
Chen HM, Yang YH, Chen KJ, et al. Antidepressants reduced risk of mortality in patients with diabetes mellitus: a population-based cohort study in Taiwan [published online July 2, 2019]. J Clin Endocrinol Metab. doi:10.1210/jc.2018-02362