Antidepressants reduce death rates by over a third in patients with diabetes

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Antidepressants may reduce deaths by more than a third in patients with diabetes and depression, according to a Taiwanese study.

People with diabetes are two to three times more likely to have depression than people without diabetes, according to the US Centres for Disease Control and Prevention. Half to three-quarters of people with diabetes and depression go undiagnosed, despite therapy and medicine being very effective.

“The incidence of major depressive disorder amongst individuals with diabetes is significantly greater than the general population,” said the study’s corresponding author, Vincent Chin-Hung Chen, professor, of Chiayi Chang Gung Memorial Hospital and Chang Gung University in Puzi, Taiwan. “Diabetes and depression each independently contribute to increasing total mortality.”

In this large population-based study, researchers used the National Health Insurance Research Database in Taiwan to identify 53,412 patients diagnosed with diabetes and depression since 2000. The researchers followed this population until 2013 to see if antidepressants reduced the death rate. They found that antidepressants significantly reduced mortality by 35%.

“This data provides further rationale for the screening and treating of depression in persons who have diabetes,” Chen said.

Context: The effect of antidepressants (ATDs) use on mortality in patients with diabetes mellitus (DM) has not yet been sufficiently studied although co-morbid 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 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 ATDs use was explored adjusting for cumulative dosing.
Result: Using the time-dependent Cox regression model, ATDs use was associated with significantly reduced mortality among patients with DM (in the highest dose group, hazard ratio [HR]= 0.65, 95% confidence interval [CI]= 0.59-0.71). Further analysis showed that differences on mortality existed across ATD categories: 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), trazodone (HR=0.52, 95% CI= 0.29-0.91). However, reversible inhibitor of monoamine oxidase A (RIMA) was found to be associated with an increase, rather than decrease, in total mortality. (HR=1.48, 95% CI= 1.09-1.99).
Conclusion: Most ATDs but not RIMA were associated with significantly reduced mortality among population with comorbid DM and depression.

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

The Endocrine Society material
Journal of Clinical Endocrinology & Metabolism abstract

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