Association between polypharmacy and depression relapse in individuals with comorbid depression and type 2 diabetes: a UK electronic health record study

Abstract

Background Individuals with physical comorbidities and polypharmacy may be at higher risk of depression relapse, however, they are not included in the ‘high risk of relapse’ group for whom longer antidepressant treatment durations are recommended. Aims In individuals with comorbid depression and type 2 diabetes (T2DM), we aimed to investigate the association and interaction between depression relapse and (a) polypharmacy, (b) previous duration of antidepressant treatment. Method This was a cohort study using primary care data from the UK Clinical Practice Research Datalink (CPRD) from years 2000 to 2018. We used Cox regression models with penalised B-splines to describe the association between restarting antidepressants and our two exposures. Results We identified 48 001 individuals with comorbid depression and T2DM, who started and discontinued antidepressant treatment during follow-up. Within 1 year of antidepressant discontinuation, 35% of participants restarted treatment indicating depression relapse. As polypharmacy increased, the rate of restarting antidepressants increased until a maximum of 18 concurrent medications, where individuals were more than twice as likely to restart antidepressants (hazard ratio (HR) = 2.15, 95% CI 1.32–3.51). As the duration of previous antidepressant treatment increased, the rate of restarting antidepressants increased – individuals with a previous duration of ≥25 months were more than twice as likely to restart antidepressants than those who previously discontinued in <7 months (HR = 2.36, 95% CI 2.25–2.48). We found no interaction between polypharmacy and previous antidepressant duration. Conclusions Polypharmacy and longer durations of previous antidepressant treatment may be associated with depression relapse following the discontinuation of antidepressant treatment.

Antidepressant prescribing inequalities in people with comorbid depression and type 2 diabetes: a UK primary care electronic health record study

“…Antidepressants are also known to cause cardiac symptoms, which may be of concern to people with a condition such as type 2 diabetes, which can lead to cardiovascular disease. Although antidepressants were shown to improve glycaemic control in a systematic review of RCTs, they have also been shown in observational studies to be associated with hyperglycaemia (24) and starting insulin (25), as well as hypoglycaemia (26) (though all these may have been subject to confounding by indication). Despite the need to successfully treat depression in order effectively manage physical health in type 2 diabetes, without clear evidence on the benefits and harms of antidepressant medication in this patient group, and accompanying treatment guidelines, it is understandable that clinicians may be wary to prescribe.…”

Mental Health Polypharmacy in “Non-Coded” Primary Care Patients: The Effect of Deprescribing

“…Such situations often arise in cases where patients present with multiple comorbidities requiring treatment from different therapeutic classes, or when monotherapy does not yield the desired clinical improvement. Consequently, deprescribing may not always be an appropriate strategy [21].…”