Jari Tiihonen1, Ellenor Mittendorfer-Rutz1, Minna Torniainen1, Kristina Alexanderson1, Antti Tanskanen1. 1. From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm; the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio; and the Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki.
Abstract
OBJECTIVE: Although mortality related to psychotropic medications has received much attention in recent years, little is known about the relationship between risk of death and cumulative antipsychotic load, and even less about the relationship between mortality and cumulative exposure to antidepressants or benzodiazepines. The authors examined these relationships using nationwide databases. METHOD: The authors used prospectively collected nationwide databases to identify all individuals 16-65 years of age with a schizophrenia diagnosis (N=21,492) in Sweden. All-cause and cause-specific mortality rates were calculated as a function of cumulative low, moderate, and high exposure to antipsychotics, antidepressants, and benzodiazepines from 2006 through 2010. RESULTS: Compared with no exposure, both moderate (adjusted hazard ratio=0.59, 95% CI=0.49-0.70) and high (adjusted hazard ratio=0.75, 95% CI=0.63-0.89) antipsychotic exposures were associated with substantially lower overall mortality. Moderate antidepressant exposure was associated with a lower mortality (adjusted hazard ratio=0.85, 95% CI=0.73-0.98), and high exposure, even lower (adjusted hazard ratio=0.71, 95% CI=0.59-0.86). Exposure to benzodiazepines showed a dose-response relationship with mortality (hazard ratios up to 1.74 [95% CI=1.50-2.03]). CONCLUSIONS: Moderate and high-dose antipsychotic and antidepressant use were associated with 15%-40% lower overall mortality, whereas chronic high-dose use of benzodiazepines was associated with up to a 70% higher risk of death compared with no exposure. Since patients with anxiety and depressive symptoms may have a higher intrinsic risk of death, the finding for benzodiazepines may be attributable to some extent to residual confounding.
OBJECTIVE: Although mortality related to psychotropic medications has received much attention in recent years, little is known about the relationship between risk of death and cumulative antipsychotic load, and even less about the relationship between mortality and cumulative exposure to antidepressants or benzodiazepines. The authors examined these relationships using nationwide databases. METHOD: The authors used prospectively collected nationwide databases to identify all individuals 16-65 years of age with a schizophrenia diagnosis (N=21,492) in Sweden. All-cause and cause-specific mortality rates were calculated as a function of cumulative low, moderate, and high exposure to antipsychotics, antidepressants, and benzodiazepines from 2006 through 2010. RESULTS: Compared with no exposure, both moderate (adjusted hazard ratio=0.59, 95% CI=0.49-0.70) and high (adjusted hazard ratio=0.75, 95% CI=0.63-0.89) antipsychotic exposures were associated with substantially lower overall mortality. Moderate antidepressant exposure was associated with a lower mortality (adjusted hazard ratio=0.85, 95% CI=0.73-0.98), and high exposure, even lower (adjusted hazard ratio=0.71, 95% CI=0.59-0.86). Exposure to benzodiazepines showed a dose-response relationship with mortality (hazard ratios up to 1.74 [95% CI=1.50-2.03]). CONCLUSIONS: Moderate and high-dose antipsychotic and antidepressant use were associated with 15%-40% lower overall mortality, whereas chronic high-dose use of benzodiazepines was associated with up to a 70% higher risk of death compared with no exposure. Since patients with anxiety and depressive symptoms may have a higher intrinsic risk of death, the finding for benzodiazepines may be attributable to some extent to residual confounding.
Authors: Heidi Taipale; Antti Tanskanen; Juha Mehtälä; Pia Vattulainen; Christoph U Correll; Jari Tiihonen Journal: World Psychiatry Date: 2020-02 Impact factor: 49.548
Authors: Christoph U Correll; Marco Solmi; Nicola Veronese; Beatrice Bortolato; Stella Rosson; Paolo Santonastaso; Nita Thapa-Chhetri; Michele Fornaro; Davide Gallicchio; Enrico Collantoni; Giorgio Pigato; Angela Favaro; Francesco Monaco; Cristiano Kohler; Davy Vancampfort; Philip B Ward; Fiona Gaughran; André F Carvalho; Brendon Stubbs Journal: World Psychiatry Date: 2017-06 Impact factor: 49.548
Authors: Jari Tiihonen; Ellenor Mittendorfer-Rutz; Maila Majak; Juha Mehtälä; Fabian Hoti; Erik Jedenius; Dana Enkusson; Amy Leval; Jan Sermon; Antti Tanskanen; Heidi Taipale Journal: JAMA Psychiatry Date: 2017-07-01 Impact factor: 21.596