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) |
---|---|---|---|---|
66S3.00 | full care by hospice | res176: Palliative and end of life care | diagnostic | Read |
66S4.00 | shared care - hospice / gp | res176: Palliative and end of life care | diagnostic | Read |
8B2a.00 | prescription of palliative care anticipatory medication | res176: Palliative and end of life care | diagnostic | Read |
8BA2.11 | end of life care | res176: Palliative and end of life care | diagnostic | Read |
8BAN.00 | community specialist palliative care | res176: Palliative and end of life care | diagnostic | Read |
8BAP.00 | specialist palliative care | res176: Palliative and end of life care | diagnostic | Read |
8BAQ.00 | final days pathway | res176: Palliative and end of life care | diagnostic | Read |
8BAR.00 | specialist palliative care treatment - inpatient | res176: Palliative and end of life care | diagnostic | Read |
8BAS.00 | specialist palliative care treatment - daycare | res176: Palliative and end of life care | diagnostic | Read |
8BAT.00 | specialist palliative care treatment - outpatient | res176: Palliative and end of life care | diagnostic | Read |
8BAe.00 | anticipatory palliative care | res176: Palliative and end of life care | diagnostic | Read |
8BJ1.00 | palliative treatment | res176: Palliative and end of life care | diagnostic | Read |
8BMM.00 | issue of palliative care anticipatory medication box | res176: Palliative and end of life care | diagnostic | Read |
8BMM.11 | issue of palliative care just in case box | res176: Palliative and end of life care | diagnostic | Read |
8CM1.00 | on gold standards palliative care framework | res176: Palliative and end of life care | diagnostic | Read |
8CMW300 | end of life care pathway | res176: Palliative and end of life care | diagnostic | Read |
8H7g.00 | referral to palliative care service | res176: Palliative and end of life care | diagnostic | Read |
8HH7.00 | referred to community specialist palliative care team | res176: Palliative and end of life care | diagnostic | Read |
8HX..00 | admission to hospice | res176: Palliative and end of life care | diagnostic | Read |
8HX0.00 | urgent admission to hospice | res176: Palliative and end of life care | diagnostic | Read |
8HX1.00 | routine admission to hospice | res176: Palliative and end of life care | diagnostic | Read |
8HX2.00 | admission to hospice for respite | res176: Palliative and end of life care | diagnostic | Read |
8HY..00 | referral to hospice | res176: Palliative and end of life care | diagnostic | Read |
8Hg0.00 | discharged from community specialist palliative care team | res176: Palliative and end of life care | diagnostic | Read |
8HgX.00 | discharge from palliative care service | res176: Palliative and end of life care | diagnostic | Read |
8Hga.00 | discharge from hospice | res176: Palliative and end of life care | diagnostic | Read |
949A.00 | patient died in hospice | res176: Palliative and end of life care | diagnostic | Read |
949G.00 | patient died in hospice community lodge | res176: Palliative and end of life care | diagnostic | Read |
9NNZ.00 | has end of life care pathway key worker | res176: Palliative and end of life care | diagnostic | Read |
9NNd.00 | under care of palliative care specialist nurse | res176: Palliative and end of life care | diagnostic | Read |
9NNf000 | under care of palliative care physician | res176: Palliative and end of life care | diagnostic | Read |
9Ng7.00 | on end of life care register | res176: Palliative and end of life care | diagnostic | Read |
9NgD.00 | under care of palliative care service | res176: Palliative and end of life care | diagnostic | Read |
9Nh0.00 | under the care of community palliative care team | res176: Palliative and end of life care | diagnostic | Read |
9NkJ.00 | seen in hospice | res176: Palliative and end of life care | diagnostic | Read |
9NlJ.00 | seen by palliative care service | res176: Palliative and end of life care | diagnostic | Read |
9b1B.00 | hospice - nhs | res176: Palliative and end of life care | diagnostic | Read |
9b1C.00 | hospice - independent | res176: Palliative and end of life care | diagnostic | Read |
9b74.00 | hospice | res176: Palliative and end of life care | diagnostic | Read |
9b74000 | hospice community lodge | res176: Palliative and end of life care | diagnostic | Read |
9b9B.00 | palliative medicine | res176: Palliative and end of life care | diagnostic | Read |
9c0L000 | planned palliative oncology treatment | res176: Palliative and end of life care | diagnostic | Read |
9c0P.00 | current palliative oncology treatment | res176: Palliative and end of life care | diagnostic | Read |
9e02.00 | notif to primary care oohs of palliative care plan in place | res176: Palliative and end of life care | diagnostic | Read |
M270300 | hospice acquired pressure ulcer | res176: Palliative and end of life care | diagnostic | Read |
Z172.00 | palliative care | res176: Palliative and end of life care | diagnostic | Read |
ZL18R00 | under care of palliative care physician | res176: Palliative and end of life care | diagnostic | Read |
ZL5AP00 | referral to palliative care physician | res176: Palliative and end of life care | diagnostic | Read |
ZL9AR00 | seen by palliative care physician | res176: Palliative and end of life care | diagnostic | Read |
ZLD3R00 | discharge by palliative care physician | res176: Palliative and end of life care | diagnostic | Read |
ZLE6P00 | discharge from palliative care service | res176: Palliative and end of life care | diagnostic | Read |
ZLF1.00 | discharge from hospice | res176: Palliative and end of life care | diagnostic | Read |
ZLF1100 | discharge from hospice day hospital | res176: Palliative and end of life care | diagnostic | Read |
ZV57C00 | [v]palliative care | res176: Palliative and end of life care | diagnostic | Read |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH869/version/1817/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH869/version/1817/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH869/version/1817/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH869/version/1817/export/codes/?format=json |
CSV | site_root/phenotypes/PH869/version/1817/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
1817 | Palliative and end of life care | 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.