Antidepressants Reduced Risk of Mortality in Patients With Diabetes Mellitus: A Population-Based Cohort Study in Taiwan

Hong Ming Chen, Yao Hsu Yang, Ko Jung Chen, Yena Lee, Roger S. McIntyre, Mong Liang Lu, Yi Chen Lee, Ming Chia Hsieh, Vincent Chin Hung Chen

Research output: Contribution to journalArticle

Abstract

CONTEXT: The effect of antidepressant (ATD) use on mortality in patients with diabetes mellitus (DM) has not yet been sufficiently studied, although comorbid depression is common in this population. OBJECTIVE: To explore the impact of ATDs on mortality among DM patients. DESIGN: A retrospective cohort study in a national database. SETTING: This population-based study used the National Health Insurance Research Database in Taiwan. Since 2000, we identified 53,412 cases of newly diagnosed patients with DM and depression. Patient cases were followed for assessing mortality until 2013. MAIN OUTCOME MEASURE: The association between mortality and ATD use was explored adjusting for cumulative dosing. RESULTS: Using the time-dependent Cox regression model, ATD use was associated with significantly reduced mortality among patients with DM [in the highest dose group: hazard ratio (HR), 0.65; 95% CI, 0.59 to 0.71]. Further analysis showed that differences in mortality existed across ATD categories: selective serotonin reuptake inhibitors (HR, 0.63; 95% CI, 0.56 to 0.71), serotonin-norepinephrine reuptake inhibitors (HR, 0.58; 95% CI, 0.44 to 0.78), norepinephrine-dopamine reuptake inhibitors (HR, 0.20; 95% CI, 0.07 to 0.63), mirtazapine (HR, 0.60; 95% CI, 0.45 to 0.82), tricyclic/tetracyclic antidepressants (HR, 0.73; 95% CI, 0.54 to 0.97), and trazodone (HR, 0.52; 95% CI, 0.29 to 0.91). However, reversible inhibitor of monoamine oxidase A (RIMA) was found to be associated with an increase, rather than a decrease, in total mortality (HR, 1.48; 95% CI, 1.09 to 1.99). CONCLUSION: Most ATDs, but not RIMA, were associated with significantly reduced mortality among a population with comorbid DM and depression.

Original languageEnglish
Pages (from-to)4619-4625
Number of pages7
JournalThe Journal of clinical endocrinology and metabolism
Volume104
Issue number10
DOIs
Publication statusPublished - Oct 1 2019

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Medical problems
Taiwan
Antidepressive Agents
Hazards
Diabetes Mellitus
Cohort Studies
Mortality
Population
Monoamine Oxidase Inhibitors
Dopamine Uptake Inhibitors
Databases
Trazodone
Health insurance
Tricyclic Antidepressive Agents
Serotonin Uptake Inhibitors
National Health Programs
Proportional Hazards Models
Norepinephrine
Retrospective Studies
Research

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Antidepressants Reduced Risk of Mortality in Patients With Diabetes Mellitus : A Population-Based Cohort Study in Taiwan. / Chen, Hong Ming; Yang, Yao Hsu; Chen, Ko Jung; Lee, Yena; McIntyre, Roger S.; Lu, Mong Liang; Lee, Yi Chen; Hsieh, Ming Chia; Chen, Vincent Chin Hung.

In: The Journal of clinical endocrinology and metabolism, Vol. 104, No. 10, 01.10.2019, p. 4619-4625.

Research output: Contribution to journalArticle

Chen, Hong Ming ; Yang, Yao Hsu ; Chen, Ko Jung ; Lee, Yena ; McIntyre, Roger S. ; Lu, Mong Liang ; Lee, Yi Chen ; Hsieh, Ming Chia ; Chen, Vincent Chin Hung. / Antidepressants Reduced Risk of Mortality in Patients With Diabetes Mellitus : A Population-Based Cohort Study in Taiwan. In: The Journal of clinical endocrinology and metabolism. 2019 ; Vol. 104, No. 10. pp. 4619-4625.
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abstract = "CONTEXT: The effect of antidepressant (ATD) use on mortality in patients with diabetes mellitus (DM) has not yet been sufficiently studied, although comorbid depression is common in this population. OBJECTIVE: To explore the impact of ATDs on mortality among DM patients. DESIGN: A retrospective cohort study in a national database. SETTING: This population-based study used the National Health Insurance Research Database in Taiwan. Since 2000, we identified 53,412 cases of newly diagnosed patients with DM and depression. Patient cases were followed for assessing mortality until 2013. MAIN OUTCOME MEASURE: The association between mortality and ATD use was explored adjusting for cumulative dosing. RESULTS: Using the time-dependent Cox regression model, ATD use was associated with significantly reduced mortality among patients with DM [in the highest dose group: hazard ratio (HR), 0.65; 95{\%} CI, 0.59 to 0.71]. Further analysis showed that differences in mortality existed across ATD categories: selective serotonin reuptake inhibitors (HR, 0.63; 95{\%} CI, 0.56 to 0.71), serotonin-norepinephrine reuptake inhibitors (HR, 0.58; 95{\%} CI, 0.44 to 0.78), norepinephrine-dopamine reuptake inhibitors (HR, 0.20; 95{\%} CI, 0.07 to 0.63), mirtazapine (HR, 0.60; 95{\%} CI, 0.45 to 0.82), tricyclic/tetracyclic antidepressants (HR, 0.73; 95{\%} CI, 0.54 to 0.97), and trazodone (HR, 0.52; 95{\%} CI, 0.29 to 0.91). However, reversible inhibitor of monoamine oxidase A (RIMA) was found to be associated with an increase, rather than a decrease, in total mortality (HR, 1.48; 95{\%} CI, 1.09 to 1.99). CONCLUSION: Most ATDs, but not RIMA, were associated with significantly reduced mortality among a population with comorbid DM and depression.",
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AU - Lee, Yena

AU - McIntyre, Roger S.

AU - Lu, Mong Liang

AU - Lee, Yi Chen

AU - Hsieh, Ming Chia

AU - Chen, Vincent Chin Hung

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N2 - CONTEXT: The effect of antidepressant (ATD) use on mortality in patients with diabetes mellitus (DM) has not yet been sufficiently studied, although comorbid depression is common in this population. OBJECTIVE: To explore the impact of ATDs on mortality among DM patients. DESIGN: A retrospective cohort study in a national database. SETTING: This population-based study used the National Health Insurance Research Database in Taiwan. Since 2000, we identified 53,412 cases of newly diagnosed patients with DM and depression. Patient cases were followed for assessing mortality until 2013. MAIN OUTCOME MEASURE: The association between mortality and ATD use was explored adjusting for cumulative dosing. RESULTS: Using the time-dependent Cox regression model, ATD use was associated with significantly reduced mortality among patients with DM [in the highest dose group: hazard ratio (HR), 0.65; 95% CI, 0.59 to 0.71]. Further analysis showed that differences in mortality existed across ATD categories: selective serotonin reuptake inhibitors (HR, 0.63; 95% CI, 0.56 to 0.71), serotonin-norepinephrine reuptake inhibitors (HR, 0.58; 95% CI, 0.44 to 0.78), norepinephrine-dopamine reuptake inhibitors (HR, 0.20; 95% CI, 0.07 to 0.63), mirtazapine (HR, 0.60; 95% CI, 0.45 to 0.82), tricyclic/tetracyclic antidepressants (HR, 0.73; 95% CI, 0.54 to 0.97), and trazodone (HR, 0.52; 95% CI, 0.29 to 0.91). However, reversible inhibitor of monoamine oxidase A (RIMA) was found to be associated with an increase, rather than a decrease, in total mortality (HR, 1.48; 95% CI, 1.09 to 1.99). CONCLUSION: Most ATDs, but not RIMA, were associated with significantly reduced mortality among a population with comorbid DM and depression.

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