Antidepressant use and all-cause mortality in depressed individuals: A real-world cohort study

TL;DR

This study found no significant link between antidepressant use and increased mortality in people with depression after adjusting for other factors.

Contribution

The study provides real-world evidence that antidepressant use is not significantly associated with higher mortality in depressed individuals.

Findings

Antidepressant users had a higher crude mortality rate (16.5%) compared to non-users (12.2%).

After adjusting for covariates, antidepressant use was not significantly associated with mortality (adjusted HR = 0.92).

Propensity score analyses also showed no significant link between antidepressant use and mortality.

Abstract

While antidepressants are effective in alleviating symptoms, their association with mortality remains unclear. This research investigated the link between antidepressant usage and all-cause mortality among depressed patients.

We performed a real-world study on 5,947 adults with depression using a dataset from the National Health and Nutrition Examination Survey (2005–2018). Depression was identified by a Patient Health Questionnaire-9 score ≥10, or the use of antidepressants, with all-cause mortality assessed through the National Death Index. Covariates included demographics, socioeconomic status, lifestyle factors, and chronic conditions. The study performed weighted Cox proportional-hazards models, propensity score methods, and inverse probability of treatment weighting (IPTW) to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for comparing mortality risk between patients treated with antidepressants and those who were not. We conducted sensitivity analyses to evaluate the robustness of our findings.

During the median 82-month follow-up period, 15.0% of participants (n = 894) died. Antidepressant users (n = 3,925) had a crude mortality rate of 16.5%, compared to 12.2% in non-users (n = 2,022). The crude Cox proportional-hazards analysis indicated that antidepressant use was linked to a non-significant elevation in mortality (HR = 1.18, 95% CI 0.95–1.47, P = 0.126). This association attenuated completely after covariate adjustment (adjusted HR = 0.92, 95% CI 0.75–1.13). Propensity score analyses indicated no significant link between antidepressant use and mortality (IPTW, HR = 0.96, 95% CI 0.80–1.16, P = 0.707). Across all methods, no statistically significant association was observed.

All-cause mortality is not significantly affected by the overall use of antidepressants in individuals with depression; however, future studies should investigate safety differences between specific drug classes.

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