Antidepressants tied to reduced mortality in diabetes
The use of antidepressants is tied to a reduced mortality risk among patients with diabetes mellitus and depression, according to a retrospective study from Taiwan.
“[This study identified] an inverse association between antidepressant use and mortality among individuals diagnosed with diabetes and comorbid depression [with a] higher dose of antidepressant … linked to lower mortality,” said the researchers. “The inverse effect existed across different types of antidepressants,” they added.
The study was conducted using data from the National Health Insurance Research Database in Taiwan and included 53,412 individuals newly diagnosed with diabetes and depression (between 2000 and 2013), of whom 50,532 were on antidepressants. The follow-up duration ranged from 9.2 to 9.9 years depending on antidepressant dose. Individuals with a history of antidepressant use prior to diagnosis of diabetes were excluded.
Use of antidepressants was tied to a significant reduction in mortality risk among patients with diabetes, with the risk reducing with a higher cumulative antidepressant dose (hazard ratio [HR], 0.65, 95 percent confidence interval [CI], 0.59–0.71 for the highest vs lowest antidepressant dose group [cumulative defined daily dose (cDDD) ≥84 vs <28]; p<0.0001). [J Clin Endocrinol Metab 2019;doi:10.1210/jc.2018-02362]
This reduction in mortality rate with the highest antidepressant cDDD was observed regardless of whether patients were on selective serotonin reuptake inhibitors (SSRIs; HR, 0.64, 95 percent CI, 0.57–0.71; p<0.0001), serotonin-norepinephrine reuptake inhibitors (SNRIs; HR, 0.59, 95 percent CI, 0.44–0.80; p=0.0005), norepinephrine-dopamine reuptake inhibitors (NDRIs; HR, 0.20, 95 percent CI, 0.07–0.63; p=0.0056), tricyclic/tetracyclic antidepressants (HR, 0.73, 95 percent CI, 0.54–0.97; p=0.0311), trazodone (HR, 0.52, 95 percent CI, 0.29–0.91; p=0.0230), or mirtazapine (HR, 0.60, 95 percent CI, 0.45–0.82; p=0.0011).
Conversely, use of reversible inhibitor of monoamine oxidase A was associated with a significantly increased risk of mortality, be it at a lower cDDD (28–83; HR, 1.91, 95 percent CI, 1.39–2.61; p<0.0001) or highest cDDD (HR, 1.48, 95 percent CI, 1.09–1.99; p=0.0111).
The mortality risk was higher in male than female patients with diabetes (HR, 1.71; p<0.0001), increased with age (HR, 1.58 and 3.44 for age 45–64 and ≥65 years vs 18–44 years; p<0.0001 for both), and was also elevated in patients with heart failure (HR, 1.45; p<0.0001), end-stage renal disease (HR, 2.73; p<0.0001), chronic obstructive pulmonary disease (HR, 1.07; p=0.0105), or malignancies (HR, 3.16; p<0.0001).
“The incidence of major depressive disorder amongst individuals with diabetes is significantly greater than the general population,” said corresponding author Professor Vincent Chin-Hung Chen from the Chiayi Chang Gung Memorial Hospital and Chang Gung University in Puzi, Taiwan. “Diabetes and depression each independently contribute to increasing total mortality.”
One of the reasons cited for the reduced mortality is the modulation of inflammatory systems with antidepressants, said the researchers. Another possible mechanism is that “antidepressants exerted a salutary effect on the coagulation profile in individuals with diabetes and depression.”
The researchers acknowledged that the lack of information on cause of death may have affected the results as it could have potentially shed light on the mechanism behind the reduced mortality with antidepressants. Not accounting for lifestyle factors such as obesity and smoking history may also have influenced the results, they said.
“[Nonetheless,] this data provides further rationale for the screening and treating of depression in persons who have diabetes,” said Chen.