Excess deaths in treatment-resistant depression.
Philip Brenner1, Johan Reutfors2, Michel Nijs3
1Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden.
Therapeutic Advances in Psychopharmacology
|April 29, 2021
Summary
Patients with treatment-resistant depression (TRD) face a higher risk of premature death. This study quantifies these excess deaths, primarily due to external causes like suicide and accidents.
Area of Science:
- Clinical Psychiatry
- Epidemiology
- Public Health
Background:
- Treatment-resistant depression (TRD) is associated with increased mortality risk.
- Absolute excess death numbers for TRD patients remain largely unquantified.
Purpose of the Study:
- To quantify the excess mortality associated with TRD.
- To compare mortality risks between TRD and other depression patients.
- To identify demographic and comorbidity factors influencing excess deaths in TRD.
Main Methods:
- Utilized Swedish national registers for a cohort of 118,774 antidepressant initiators.
- Classified TRD based on initiating a third consecutive treatment trial.
- Employed flexible parametric survival models to estimate mortality risks and excess deaths, adjusting for covariates.
Main Results:
- TRD patients experienced 7-16 excess deaths per 1000 patients over 5 years compared to other depressed patients.
- The highest excess mortality was observed in younger patients (18-29 years) with low comorbidity (CCI 1).
- External causes, including suicide and accidents, constituted the majority of excess deaths.
Conclusions:
- Patients with TRD experience a significant excess mortality burden.
- This excess mortality highlights the critical need for improved management and support for TRD patients.
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