Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study

Abstract

Objective: Although mortality related to psychotropic medications has received much attention in recent years, little is known about the relationship between risk of death and cumulative antipsychotic load, and even less about the relationship between mortality and cumulative exposure to antidepressants or benzodiazepines. The authors examined these relationships using nationwide databases. Method:The authors used prospectively collected nationwide databases to identify all individuals 16-65 years of age with a schizophrenia diagnosis (N=21,492) in Sweden. All-cause and cause-specific mortality rates were calculated as a function of cumulative low, moderate, and high exposure to antipsychotics, antidepressants, and benzodiazepines from 2006 through 2010.Results: Compared with no exposure, both moderate (adjusted hazard ratio=0.59, 95% CI=0.49-0.70) and high (adjusted hazard ratio=0.75, 95% CI=0.63-0.89) antipsychotic exposures were associated with substantially lower overall mortality. Moderate antidepressant exposure was associated with a lower mortality (adjusted hazard ratio=0.85, 95% CI=0.73-0.98), and high exposure, even lower (adjusted hazard ratio=0.71, 95% CI=0.59-0.86). Exposure to benzodiazepines showed a dose-response relationship with mortality (hazard ratios up to 1.74 [95% CI=1.50-2.03]).Conclusions: Moderate and high-dose antipsychotic and antidepressant use were associated with 15%-40% lower overall mortality, whereas chronic high-dose use of benzodiazepines was associated with up to a 70% higher risk of death compared with no exposure. Since patients with anxiety and depressive symptoms may have a higher intrinsic risk of death, the finding for benzodiazepines may be attributable to some extent to residual confounding.

Do adverse perinatal events predict mortality in schizophrenia during midlife?

“…Mediating factors near the onset of psychoses maybe more important predictors of mortality (Suvisaari et al 2013;Fazel et al 2014;Joukamaa et al 2006;Ran et al 2007;Tiihonen et al 2016), which was not the focus of our study. Due to the small number of deaths in women with psychoses we were not able to conduct gender-specific analyses.…”

“…Suggested reasons for excess mortality are unhealthy lifestyle (Connolly and Kelly 2005;Laursen et al 2012;Ringen et al 2014;Suvisaari et al 2013) and use (Joukamaa et al 2006) or non-use of antipsychotics (Tiihonen et al 2016;Torniainen and et al 2015). Studies have mainly focused on predictors of mortality prevalent in the later stages of life (Fazel et al 2014;Joukamaa et al 2006;Suvisaari et al 2013;Tiihonen et al 2016) reporting that self-harm, alcohol/drug use disorders (Fazel et al 2014), older age at onset of schizophrenia, long duration of illness and inability to work are predictors of mortality (Ran et al 2007).…”

“…Studies have mainly focused on predictors of mortality prevalent in the later stages of life (Fazel et al 2014;Joukamaa et al 2006;Suvisaari et al 2013;Tiihonen et al 2016) reporting that self-harm, alcohol/drug use disorders (Fazel et al 2014), older age at onset of schizophrenia, long duration of illness and inability to work are predictors of mortality (Ran et al 2007). More information also from earlier stages of life is needed.…”

More than Half of Patients with Schizophrenia Are Receiving Polypharmacy and Co-Prescription of Anxiolytics in Pakistan —Findings from Research on Asian Prescription Pattern in 2016

“…A recent publication on psychotropic drugs in patients with schizophreniashowed that exposure to benzodiazepines has a dose-response relationship with mortality hazard ratios up to 1.74 [24]. In other words, patients with a chronic high dose usage of benzodiazepine have been associated with a higher risk of death as compared to those without exposure to benzodiazepines.…”

Psykiatriens indre konflikter eksponert

“…Det er omdiskutert hvor effektive de antipsykotiske midlene er (9), og mange slutter med medisiner på grunn av bivirkninger (10). Samtidig kan antipsykotika ved psykoser redusere dødelighet (11). Kan man da likevel forsvare medisinfrie tilbud?…”