Background:
Studies have reported an increased risk of mortality among people prescribed mirtazapine compared to other antidepressants. The study aimed to compare all-cause and cause-specific mortality between adults prescribed mirtazapine or other second-line antidepressants.
Methods:
This cohort study used English primary care electronic medical records, hospital admission records, and mortality data from the Clinical Practice Research Datalink (CPRD), for the period 01 January 2005 to 30 November 2018. It included people aged 18–99 years with depression first prescribed a selective serotonin reuptake inhibitor (SSRI) and then prescribed mirtazapine (5081), a different SSRI (15,032), amitriptyline (3905), or venlafaxine (1580). Follow-up was from starting to stopping the second antidepressant, with a 6-month wash-out window, censoring at the end of CPRD follow-up or 30 November 2018. Age-sex standardised rates of all-cause mortality and death due to circulatory system disease, cancer, or respiratory system disease were calculated. Survival analyses were performed, accounting for baseline characteristics using inverse probability of treatment weighting.
Results:
The cohort contained 25,598 people (median age 41 years). The mirtazapine group had the highest standardised mortality rate, with an additional 7.8 (95% confidence interval (CI) 5.9–9.7) deaths/1000 person-years compared to the SSRI group. Within 2 years of follow-up, the risk of all-cause mortality was statistically significantly higher in the mirtazapine group than in the SSRI group (weighted hazard ratio (HR) 1.62, 95% CI 1.28–2.06). No significant difference was found between the mirtazapine group and the amitriptyline (HR 1.18, 95% CI 0.85–1.63) or venlafaxine (HR 1.11, 95% CI 0.60–2.05) groups. After 2 years, the risk was significantly higher in the mirtazapine group compared to the SSRI (HR 1.51, 95% CI 1.04–2.19), amitriptyline (HR 2.59, 95% CI 1.38–4.86), and venlafaxine (HR 2.35, 95% CI 1.02–5.44) groups. The risks of death due to cancer (HR 1.74, 95% CI 1.06–2.85) and respiratory system disease (HR 1.72, 95% CI 1.07–2.77) were significantly higher in the mirtazapine than in the SSRI group.
Conclusions:
Mortality was higher in people prescribed mirtazapine than people prescribed a second SSRI, possibly reflecting residual differences in other risk factors between the groups. Identifying these potential health risks when prescribing mirtazapine may help reduce the risk of mortality.
Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland, The risk of all-cause and cause-specific mortality in people prescribed mirtazapine an active comparator cohort study using electronic health records. BMC Medicine, 20(43), 2022.
Code | Description | Entity type | Category | Coding System (Read) |
---|---|---|---|---|
1475 | h/o: trigeminal neuralgia | res176: Neuropathic pain | diagnostic | Read |
1DC1.00 | burning pain | res176: Neuropathic pain | diagnostic | Read |
1DC9.00 | shooting pain | res176: Neuropathic pain | diagnostic | Read |
1M4..00 | central post-stroke pain | res176: Neuropathic pain | diagnostic | Read |
1M8..00 | diabetic peripheral neuropathic pain | res176: Neuropathic pain | diagnostic | Read |
A531.11 | post-herpetic neuralgia | res176: Neuropathic pain | diagnostic | Read |
A531200 | postherpetic trigeminal neuralgia | res176: Neuropathic pain | diagnostic | Read |
A531300 | postherpetic polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
A531500 | postzoster neuralgia | res176: Neuropathic pain | diagnostic | Read |
A531511 | postherpetic neuralgia | res176: Neuropathic pain | diagnostic | Read |
A72x100 | mumps polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C106.12 | diabetes mellitus with neuropathy | res176: Neuropathic pain | diagnostic | Read |
C106.13 | diabetes mellitus with polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C108B00 | insulin dependent diabetes mellitus with mononeuropathy | res176: Neuropathic pain | diagnostic | Read |
C108B11 | type i diabetes mellitus with mononeuropathy | res176: Neuropathic pain | diagnostic | Read |
C108C00 | insulin dependent diabetes mellitus with polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C108J00 | insulin dependent diab mell with neuropathic arthropathy | res176: Neuropathic pain | diagnostic | Read |
C108J11 | type i diabetes mellitus with neuropathic arthropathy | res176: Neuropathic pain | diagnostic | Read |
C108J12 | type 1 diabetes mellitus with neuropathic arthropathy | res176: Neuropathic pain | diagnostic | Read |
C109A00 | non-insulin dependent diabetes mellitus with mononeuropathy | res176: Neuropathic pain | diagnostic | Read |
C109A11 | type ii diabetes mellitus with mononeuropathy | res176: Neuropathic pain | diagnostic | Read |
C109B00 | non-insulin dependent diabetes mellitus with polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C109B11 | type ii diabetes mellitus with polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C109B12 | type 2 diabetes mellitus with polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C109H00 | non-insulin dependent d m with neuropathic arthropathy | res176: Neuropathic pain | diagnostic | Read |
C109H11 | type ii diabetes mellitus with neuropathic arthropathy | res176: Neuropathic pain | diagnostic | Read |
C109H12 | type 2 diabetes mellitus with neuropathic arthropathy | res176: Neuropathic pain | diagnostic | Read |
C10EB00 | type 1 diabetes mellitus with mononeuropathy | res176: Neuropathic pain | diagnostic | Read |
C10EC00 | type 1 diabetes mellitus with polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C10EC11 | type i diabetes mellitus with polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C10EC12 | insulin dependent diabetes mellitus with polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C10EJ00 | type 1 diabetes mellitus with neuropathic arthropathy | res176: Neuropathic pain | diagnostic | Read |
C10FA00 | type 2 diabetes mellitus with mononeuropathy | res176: Neuropathic pain | diagnostic | Read |
C10FA11 | type ii diabetes mellitus with mononeuropathy | res176: Neuropathic pain | diagnostic | Read |
C10FB00 | type 2 diabetes mellitus with polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C10FB11 | type ii diabetes mellitus with polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
C10FH00 | type 2 diabetes mellitus with neuropathic arthropathy | res176: Neuropathic pain | diagnostic | Read |
C10FH11 | type ii diabetes mellitus with neuropathic arthropathy | res176: Neuropathic pain | diagnostic | Read |
C373200 | familial neuropathic amyloid | res176: Neuropathic pain | diagnostic | Read |
C373K13 | familial amyloid polyneuropathy type iii | res176: Neuropathic pain | diagnostic | Read |
F170.00 | idiopathic peripheral autonomic neuropathy | res176: Neuropathic pain | diagnostic | Read |
F170z00 | idiopathic peripheral autonomic neuropathy nos | res176: Neuropathic pain | diagnostic | Read |
F171.00 | peripheral autonomic neuropathy disease ec | res176: Neuropathic pain | diagnostic | Read |
F171000 | autonomic neuropathy due to amyloid | res176: Neuropathic pain | diagnostic | Read |
F171100 | autonomic neuropathy due to diabetes | res176: Neuropathic pain | diagnostic | Read |
F171z00 | peripheral autonomic neuropathy due to disease nos | res176: Neuropathic pain | diagnostic | Read |
F262100 | horton's (histamine) neuralgia | res176: Neuropathic pain | diagnostic | Read |
F262500 | periodic migrainous neuralgia | res176: Neuropathic pain | diagnostic | Read |
F262C00 | shortlast unilat neuralgifrm pain+conjunc inject+tearng synd | res176: Neuropathic pain | diagnostic | Read |
F300.00 | post-herpetic trigeminal neuralgia | res176: Neuropathic pain | diagnostic | Read |
F301.00 | other specified trigeminal neuralgia | res176: Neuropathic pain | diagnostic | Read |
F301000 | tic douloureux | res176: Neuropathic pain | diagnostic | Read |
F301z00 | trigeminal neuralgia nos | res176: Neuropathic pain | diagnostic | Read |
F321.00 | glossopharyngeal neuralgia | res176: Neuropathic pain | diagnostic | Read |
F335.00 | neuralgic amyotrophy | res176: Neuropathic pain | diagnostic | Read |
F336000 | phantom limb syndrome with pain | res176: Neuropathic pain | diagnostic | Read |
F342400 | ulnar neuropathy | res176: Neuropathic pain | diagnostic | Read |
F347.00 | complex regional pain syndrome type ii | res176: Neuropathic pain | diagnostic | Read |
F351.00 | meralgia paraesthetica | res176: Neuropathic pain | diagnostic | Read |
F356100 | morton's neuralgia | res176: Neuropathic pain | diagnostic | Read |
F36..00 | hereditary and idiopathic peripheral neuropathy | res176: Neuropathic pain | diagnostic | Read |
F360.00 | hereditary peripheral neuropathy | res176: Neuropathic pain | diagnostic | Read |
F360z00 | hereditary peripheral neuropathy nos | res176: Neuropathic pain | diagnostic | Read |
F362.00 | hereditary sensory neuropathy | res176: Neuropathic pain | diagnostic | Read |
F364.00 | idiopathic progressive polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
F365.00 | neuropathy in association with hereditary ataxia | res176: Neuropathic pain | diagnostic | Read |
F366.00 | polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
F367.00 | peripheral neuropathy | res176: Neuropathic pain | diagnostic | Read |
F368.00 | hereditary motor and sensory neuropathy | res176: Neuropathic pain | diagnostic | Read |
F368000 | hereditary motor and sensory neuropathy type i | res176: Neuropathic pain | diagnostic | Read |
F368100 | hereditary motor and sensory neuropathy type ii | res176: Neuropathic pain | diagnostic | Read |
F368200 | hereditary motor and sensory neuropathy type iii | res176: Neuropathic pain | diagnostic | Read |
F369.00 | complex regional pain syndrome | res176: Neuropathic pain | diagnostic | Read |
F369.11 | chronic regional pain syndrome | res176: Neuropathic pain | diagnostic | Read |
F36y.00 | other idiopathic peripheral neuropathy | res176: Neuropathic pain | diagnostic | Read |
F36yz00 | other idiopathic peripheral neuropathy nos | res176: Neuropathic pain | diagnostic | Read |
F36z.00 | hereditary or idiopathic peripheral neuropathy nos | res176: Neuropathic pain | diagnostic | Read |
F37..00 | inflammatory and toxic neuropathy | res176: Neuropathic pain | diagnostic | Read |
F37..11 | toxic neuropathy | res176: Neuropathic pain | diagnostic | Read |
F371.00 | polyneuropathy in collagen vascular disease | res176: Neuropathic pain | diagnostic | Read |
F371000 | polyneuropathy in disseminated lupus erythematosus | res176: Neuropathic pain | diagnostic | Read |
F371100 | polyneuropathy in polyarteritis nodosa | res176: Neuropathic pain | diagnostic | Read |
F371z00 | polyneuropathy in collagen vascular disease nos | res176: Neuropathic pain | diagnostic | Read |
F372.00 | polyneuropathy in diabetes | res176: Neuropathic pain | diagnostic | Read |
F372.11 | diabetic polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
F372.12 | diabetic neuropathy | res176: Neuropathic pain | diagnostic | Read |
F372000 | acute painful diabetic neuropathy | res176: Neuropathic pain | diagnostic | Read |
F372100 | chronic painful diabetic neuropathy | res176: Neuropathic pain | diagnostic | Read |
F373.00 | polyneuropathy in malignant disease | res176: Neuropathic pain | diagnostic | Read |
F374000 | polyneuropathy in amyloidosis | res176: Neuropathic pain | diagnostic | Read |
F374100 | polyneuropathy in beriberi | res176: Neuropathic pain | diagnostic | Read |
F374200 | polyneuropathy in vitamin b deficiency | res176: Neuropathic pain | diagnostic | Read |
F374300 | polyneuropathy in diphtheria | res176: Neuropathic pain | diagnostic | Read |
F374400 | polyneuropathy in herpes zoster | res176: Neuropathic pain | diagnostic | Read |
F374500 | polyneuropathy in hypoglycaemia | res176: Neuropathic pain | diagnostic | Read |
F374600 | polyneuropathy in mumps | res176: Neuropathic pain | diagnostic | Read |
F374800 | polyneuropathy in porphyria | res176: Neuropathic pain | diagnostic | Read |
F374900 | polyneuropathy in sarcoidosis | res176: Neuropathic pain | diagnostic | Read |
F374A00 | polyneuropathy in uraemia | res176: Neuropathic pain | diagnostic | Read |
F375.00 | alcoholic polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
F376.00 | polyneuropathy due to drugs | res176: Neuropathic pain | diagnostic | Read |
F377.00 | other toxic agent polyneuropathy | res176: Neuropathic pain | diagnostic | Read |
F37y.00 | other toxic or inflammatory neuropathy | res176: Neuropathic pain | diagnostic | Read |
F3y0.00 | diabetic mononeuropathy | res176: Neuropathic pain | diagnostic | Read |
Fyu1300 | [x]paraneoplastic neuromyopathy and neuropathy | res176: Neuropathic pain | diagnostic | Read |
Fyu6A00 | [x]other mononeuropathies of upper limb | res176: Neuropathic pain | diagnostic | Read |
Fyu6B00 | [x]other mononeuropathies of lower limb | res176: Neuropathic pain | diagnostic | Read |
Fyu6C00 | [x]other specified mononeuropathies | res176: Neuropathic pain | diagnostic | Read |
Fyu6D00 | [x]other mononeuropathies in diseases classified elsewhere | res176: Neuropathic pain | diagnostic | Read |
Fyu7.00 | [x]polyneuropathies & other disord of peripheral nerv syst | res176: Neuropathic pain | diagnostic | Read |
Fyu7000 | [x]other hereditary and idiopathic neuropathies | res176: Neuropathic pain | diagnostic | Read |
Fyu7200 | [x]other specified polyneuropathies | res176: Neuropathic pain | diagnostic | Read |
Fyu7500 | [x]polyneuropathy/other endocrine+metabolic diseases ce | res176: Neuropathic pain | diagnostic | Read |
Fyu7800 | [x]polyneuropathy/other musculoskeletal disorders ce | res176: Neuropathic pain | diagnostic | Read |
FyuAC00 | [x]autonomic neuropathy/endocrine+metabolic diseases ce | res176: Neuropathic pain | diagnostic | Read |
M271100 | neuropathic diabetic ulcer - foot | res176: Neuropathic pain | diagnostic | Read |
M271700 | neuropathic foot ulcer | res176: Neuropathic pain | diagnostic | Read |
M2y1500 | painful operation scar | res176: Neuropathic pain | diagnostic | Read |
N035.00 | neuropathic arthropathy | res176: Neuropathic pain | diagnostic | Read |
N035.12 | neuropathic arthritis | res176: Neuropathic pain | diagnostic | Read |
N119.00 | cervical spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N119000 | single-level cervical spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N119100 | two-level cervical spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N119200 | multiple-level cervical spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N11B.00 | thoracic spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N11B000 | single-level thoracic spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N11B100 | two-level thoracic spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N11B200 | multiple-level thoracic spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N11C.00 | lumbosacral spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N11C000 | single-level lumbosacral spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N11C100 | two-level lumbosacral spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N11C200 | multiple-level lumbosacral spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N11y200 | neuropathic spondylopathy | res176: Neuropathic pain | diagnostic | Read |
N12C.00 | disc prolapse with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N12C000 | cervical disc prolapse with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N12C100 | thoracic disc prolapse with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N12C200 | lumbar disc prolapse with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N12C400 | prolapsed lumbar intervertebral disc with sciatica | res176: Neuropathic pain | diagnostic | Read |
N12zH00 | cervical disc disorder with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
N142000 | lumbago with sciatica | res176: Neuropathic pain | diagnostic | Read |
N143.00 | sciatica | res176: Neuropathic pain | diagnostic | Read |
N143.11 | acute back pain with sciatica | res176: Neuropathic pain | diagnostic | Read |
N242.00 | neuralgia, neuritis and radiculitis unspecified | res176: Neuropathic pain | diagnostic | Read |
N242000 | neuralgia unspecified | res176: Neuropathic pain | diagnostic | Read |
N242300 | neuropathic pain | res176: Neuropathic pain | diagnostic | Read |
N242z00 | neuralgia, neuritis or radiculitis nos | res176: Neuropathic pain | diagnostic | Read |
N337.12 | reflex sympathetic dystrophy | res176: Neuropathic pain | diagnostic | Read |
N337111 | reflex sympathetic dystrophy | res176: Neuropathic pain | diagnostic | Read |
N33C.00 | complex regional pain syndrome type i | res176: Neuropathic pain | diagnostic | Read |
Nyu6300 | [x]other spondylosis with radiculopathy | res176: Neuropathic pain | diagnostic | Read |
SD72200 | neuropathic foot blister | res176: Neuropathic pain | diagnostic | Read |
SP07300 | internal prosthetic device causing pain | res176: Neuropathic pain | diagnostic | Read |
SP07A00 | pain due to hip joint prosthesis | res176: Neuropathic pain | diagnostic | Read |
SP07B00 | pain due to knee joint prosthesis | res176: Neuropathic pain | diagnostic | Read |
SP07C00 | pain due to shoulder joint prosthesis | res176: Neuropathic pain | diagnostic | Read |
SyuKE11 | [x] pain due to internal orthopaedic prosthesis | res176: Neuropathic pain | diagnostic | Read |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH868/version/1815/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH868/version/1815/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH868/version/1815/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH868/version/1815/export/codes/?format=json |
CSV | site_root/phenotypes/PH868/version/1815/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
1815 | Neuropathic Pain | ieuan.scanlon | 2022-04-04 | currently shown |
Export - export all codes into a csv file/JSON/XML for the current phenotype version.
Print - Print page.