Exposure to psychotropic medications and mortality in schizophrenia: a 5-year national cohort study

Abstract

Background Relatively few studies have explored the differential contributions of the accumulative dosage of psychotropic medications on mortality in patients with schizophrenia. Methods We aimed to explore the effects of the exposure dosage of psychotropic medications on mortality during a follow-up period of 5 years with a national cohort of individuals with schizophrenia in 2010. Causes of death were linked through Taiwan's National Mortality Registry. The mean defined daily dose of antipsychotics, antidepressants, mood stabilizers, and sedative-hypnotics, were calculated and survival analyses were conducted. Results A total of 102 964 individuals (54 151 men, 52.59%) with schizophrenia were included. Compared to patients with no exposure to antipsychotics, those with antipsychotic exposure had better survival outcomes, regardless of antipsychotic dosage. Antidepressant exposure, in low and moderate dosage, was associated with decreased all-cause mortality; exposure to mood stabilizers appeared to be associated with an increase in all-cause mortality. Although 89.7% of the patients had been prescribed sedative-hypnotics, exposure to sedative-hypnotics was associated with dose-related increased mortality risk [hazard ratio (HR) in low dose group: 1.16, 95% confidence interval (CI) 1.07–1.27; HR in moderate dose: 1.32, 95% CI 1.21–1.44; HR in high dose: 1.83, 95% CI 1.67–2.01)]. Conclusions The results indicate that in the treatment of schizophrenia, antipsychotics and antidepressants are associated with lower mortality when using adequate dosages and mood stabilizers and sedative-hypnotics with higher mortality compared with no use. Furthermore, exposure to sedative-hypnotics is associated with a dose-related increased mortality risk which warrants clinical attention and further study.

Real-world effectiveness of antidepressant use in persons with schizophrenia: within-individual study of 61,889 subjects

“…Similar findings considering antidepressant use have been found in a previous study comparing different levels of antidepressant exposure with non-use (15–40% lower risk depending on the level of exposure) 9 . Another study comparing the levels of antidepressant exposure found 17% lower risk associated with low exposure and 9% lower risk with moderate exposure, but there was no difference in risk with the highest exposure 10 . Similar trend was also seen in a previous Finnish study, even though the results were not statistically significant (HR 0.57, 95% CI, 0.28–1.16) 13 .…”

“…Only a few studies have assessed the effectiveness of antidepressant use in persons with schizophrenia in real-world settings. A previous U.S. study evaluated several outcomes related to the effectiveness and safety aspects of antidepressant augmentation 12 , and two previous studies have assessed the association between antidepressant use and mortality in schizophrenia in Nordic countries 9 , 13 , and one study in Taiwan 10 . To our knowledge, there are no previous studies investigating the effectiveness of specific antidepressants in real-world settings.…”

Feasibility and Efficacy of the Cogmed Working Memory Training in Forensic Mental Health Inpatients With Schizophrenia Spectrum Disorders: A Pilot Study

“…People living with schizophrenia are commonly reliant on a combination of pharmaceuticals such as antipsychotics, antidepressants, anxiolytics, and antimanic medications. 56 A number of these medications, such as clozapine and olanzapine, cause significant metabolic dysfunction, thought to impair cognitive function. 57 The impact of other medications used in schizophrenia on cognition is unclear.…”

Mortality in Schizophrenia-Spectrum Disorders: Recent Advances in Understanding and Management

“…More recently, the 20-year follow-up of the nationwide cohort of 62,250 patients with schizophrenia in Finland confirmed that long-term antipsychotic use does not increase severe physical morbidity in patients with schizophrenia, but rather is associated with substantially decreased mortality, especially among patients treated with clozapine [ 82 ]. Most recently, a large 5-year national cohort study in Taiwan that involved 102,964 patients with schizophrenia found that antipsychotic exposure of patients had been associated with better survival outcomes in all-cause mortality, particularly when adequate dosages were used [ 83 ]. It is worthy to mention that the use of second-generation long-acting injectable antipsychotics (LAIs) has been associated with the lowest mortality risk in patients with schizophrenia [ 84 ], whereas LAIs decreased all-cause mortality and suicide risk in newly diagnosed patients with schizophrenia [ 85 ].…”