Psychotropic drug use in patients with autoimmune Addison's disease: a Swedish population-based cohort study

The effect of autoimmune Addison's disease (AAD) on mental health is not well known. The aim of this study was to examine the use of psychotropic drugs around diagnosis and after long-term follow-up in Swedish individuals with AAD.

In this population-based cohort study, national health and population registers and the Swedish Addison Registry were used to identify individuals diagnosed with AAD between July 2006 and December 2019 and matched population controls. The Swedish Prescribed Drug Register was used to retrieve information on annual dispensations (yes/no) of anti-psychotics [Anatomical Therapeutic Chemical (ATC) N05A], anxiolytics (ATC N05B), hypnotics/sedatives (ATC N05C), and anti-depressants (ATC N06A), from 3 years before to 3 years after diagnosis. A cross-sectional analysis of the year 2019 was also performed.

A total of 963 persons with AAD and 9366 matched controls were identified. Use of hypnotics/sedatives, anxiolytics, and anti-depressants was significantly higher in patients with AAD the year preceding diagnosis [ORs 1.72 (1.40-2.11), 1.38 (1.07-1.78), and 1.29 (1.05-1.59), respectively]. After diagnosis, use of hypnotics/sedatives remained significantly higher [ORs 1.42 (1.13-1.78) to 1.78 (1.45-2.19)]. We found no difference in dispensation of other psychotropic drugs after diagnosis. In the cross-sectional analysis of 2019, the increased dispensation of hypnotics/sedatives remained elevated [odds ratio (OR) 1.31 (1.01-1.70)].

Prescription patterns suggest that early symptoms of AAD are associated with or mistaken for mental health disorders. Furthermore, insomnia is common in patients with AAD.