Associations between mortality and exposure to psychotropic medication: A population-based cohort study for depressive disorders

Background: Use of antidepressants and antipsychotics to treat depressive disorders is becoming increasingly prevalent. Methods: This study investigated how the use and cumulative dosage of these medications affect the mortality risk in a Taiwan’s national cohort of individuals ages 15 years and older who were diagnosed with depressive disorders in 2010 and followed up for 5 years. An age- and gender-matched control group was identified. The mean defined daily doses of antidepressants and antipsychotics were calculated, and survival analyses were conducted to examine the effects of exposure dosage on overall mortality and mortality due to cardiovascular diseases, in comparison with the control sample. Results: A total of 400,042 individuals (255,288 women; 63.8%) with depressive disorders were identified. A low-to-moderate dosage of antidepressants was associated with a decrease in cardiovascular disease–related mortality risks compared to no exposure for those with depressive disorders. By contrast, a dose-related increase was found when using antipsychotics, with a 1.6-, 2.4- and 2.9-fold risk in the low, moderate and high exposure groups, respectively, for overall mortality, and a 1.2-, 2.4- and 3.5-fold risk in the low, moderate and high exposure groups, respectively, for cardiovascular disease–related mortality, relative to the control sample. Conclusion: For individuals with depression, use of low-to-moderate dosage antidepressants was associated with decreased mortality. However, use of antipsychotics was found to be associated with a dose-related increase in overall and cardiovascular disease–related mortality risks. Adverse health outcomes should be also considered when prescribing psychotropic medications to patients with depressive disorders.