PDF(Pubmed)
Abstract：
BACKGROUND: Depression is associated with higher rates of premature mortality in people with physical comorbidities, such as type 2 diabetes. Conceptually, the successful treatment of depression in people with type 2 diabetes could prevent premature mortality.
OBJECTIVE: To investigate the association between antidepressant prescribing and the rates of all-cause and cause-specific (endocrine, cardiovascular, respiratory, cancer, unnatural) mortality in individuals with comorbid depression and type 2 diabetes.
METHODS: Using UK primary care records between years 2000 and 2018, we completed a nested case-control study in a cohort of people with comorbid depression and type 2 diabetes who were starting oral antidiabetic treatment for the first time. We used incident density sampling to identify cases who died and matched controls who remained alive after the same number of days observation. We estimated incidence rate ratios for the association between antidepressant prescribing and mortality, adjusting for demographic characteristics, comorbidities, medication use and health behaviours.
RESULTS: We included 5222 cases with a recorded date of death, and 18 675 controls, observed for a median of 7 years. Increased rates of all-cause mortality were associated with any antidepressant prescribing during the observation period (incidence rate ratio 2.77, 95% CI 2.48-3.10). These results were consistent across all causes of mortality that we investigated.
CONCLUSIONS: Antidepressant prescribing was highly associated with higher rates of mortality. However, we suspect that this is not a direct causal effect, but that antidepressant treatment is a marker of more severe and unsuccessfully treated depression.
OBJECTIVE: To investigate the association between antidepressant prescribing and the rates of all-cause and cause-specific (endocrine, cardiovascular, respiratory, cancer, unnatural) mortality in individuals with comorbid depression and type 2 diabetes.
METHODS: Using UK primary care records between years 2000 and 2018, we completed a nested case-control study in a cohort of people with comorbid depression and type 2 diabetes who were starting oral antidiabetic treatment for the first time. We used incident density sampling to identify cases who died and matched controls who remained alive after the same number of days observation. We estimated incidence rate ratios for the association between antidepressant prescribing and mortality, adjusting for demographic characteristics, comorbidities, medication use and health behaviours.
RESULTS: We included 5222 cases with a recorded date of death, and 18 675 controls, observed for a median of 7 years. Increased rates of all-cause mortality were associated with any antidepressant prescribing during the observation period (incidence rate ratio 2.77, 95% CI 2.48-3.10). These results were consistent across all causes of mortality that we investigated.
CONCLUSIONS: Antidepressant prescribing was highly associated with higher rates of mortality. However, we suspect that this is not a direct causal effect, but that antidepressant treatment is a marker of more severe and unsuccessfully treated depression.
摘要：
背景：在有身体合并症的人中，抑郁症与较高的过早死亡率相关，比如2型糖尿病。概念上,成功治疗2型糖尿病患者的抑郁症可以防止过早死亡。
目的：研究抗抑郁药处方与全因和特定原因（内分泌，心血管,呼吸,癌症,抑郁症和2型糖尿病合并症患者的非自然）死亡率。
方法：使用2000年至2018年的英国初级保健记录，我们在首次开始口服抗糖尿病治疗的患有抑郁症和2型糖尿病的人群中完成了一项巢式病例对照研究。我们使用事件密度采样来识别死亡的病例和在相同观察天数后仍存活的匹配对照。我们估计了抗抑郁药处方和死亡率之间关联的发生率比，根据人口特征进行调整，合并症,药物使用和健康行为。
结果：我们包括5222例记录死亡日期的病例，和18675个控件，观察到中位数为7年。在观察期间，全因死亡率的增加与任何抗抑郁药处方相关（发生率比2.77，95％CI2.48-3.10）。这些结果在我们调查的所有死亡原因中都是一致的。
结论：抗抑郁药处方与较高的死亡率高度相关。然而,我们怀疑这不是直接的因果效应，但是抗抑郁治疗是更严重和未成功治疗的抑郁症的标志。
目的：研究抗抑郁药处方与全因和特定原因（内分泌，心血管,呼吸,癌症,抑郁症和2型糖尿病合并症患者的非自然）死亡率。
方法：使用2000年至2018年的英国初级保健记录，我们在首次开始口服抗糖尿病治疗的患有抑郁症和2型糖尿病的人群中完成了一项巢式病例对照研究。我们使用事件密度采样来识别死亡的病例和在相同观察天数后仍存活的匹配对照。我们估计了抗抑郁药处方和死亡率之间关联的发生率比，根据人口特征进行调整，合并症,药物使用和健康行为。
结果：我们包括5222例记录死亡日期的病例，和18675个控件，观察到中位数为7年。在观察期间，全因死亡率的增加与任何抗抑郁药处方相关（发生率比2.77，95％CI2.48-3.10）。这些结果在我们调查的所有死亡原因中都是一致的。
结论：抗抑郁药处方与较高的死亡率高度相关。然而,我们怀疑这不是直接的因果效应，但是抗抑郁治疗是更严重和未成功治疗的抑郁症的标志。
