Most antidepressants are linked to reduced mortality in DM

  • Chen HM & al.
  • J Clin Endocrinol Metab
  • 2 Jul 2019

  • International Clinical Digest
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Takeaway

  • Most antidepressants except reversible inhibitors of monoamine oxidase A (RIMAs) are associated with significantly reduced mortality among patients with comorbid diabetes mellitus (DM) and depression.

Why this matters

  • Effect of antidepressants on mortality in patients with diabetes is not well-studied.  

Study design

  • Retrospective 2000-2013 cohort study in national Taiwanese database of 53,412 individuals with both diabetes and depression, of whom 50,532 used antidepressants.
  • Funding: Ministry of Health and Welfare, Taiwan.

Key results

  • After adjustment for factors including sex, age, income, and comorbidities, total mortality decreased with increasing antidepressants cumulative defined daily dose (cDDD):
    • At >28 vs
    • At cDDD ≥84, HR was 0.65 (P<.0001>
  • Males were at greater mortality risk than females: HR, 1.71 (P<.0001>
  • No significant effect on overall mortality for cDDD
  • Selective serotonin reuptake inhibitors: 0.64 (P<.0001>
  • Serotonin-norepinephrine reuptake inhibitors: 0.59 (P=.0005);
  • Norepinephrine-dopamine reuptake inhibitors: 0.20 (P=.0056);
  • Mirtazapine: 0.60 (P=.0011); 
  • Tricyclic/tetracyclic antidepressants: 0.73 (P=.0311); and
  • Trazodone: 0.52 (P=.0230).
  • However, with RIMAs, mortality increased vs cDDD
  • 28-83: 1.91 (P<.0001 and>
  • ≥84: 1.48 (P=.0111).
  • Limitations

    • Specific death causes unknown.
    • Validity of depression diagnosis uncertain.
    • Potential residual confounders.
    • All-Taiwanese population.