title: Antidepressant Medication Treatment and Risk of Death.
abstract: OBJECTIVE
  Although previous studies have assessed whether depression is a mortality risk factor, few have examined whether antidepressant medications (ADMs) influence mortality risk.
  
  
  METHODS
  We estimated hazards of 1-year all-cause mortality associated with ADMs, with use occurring within 90 days of depression diagnosis among 720 821 patients who received treatment in a Veterans Health Administration facility during fiscal year 2006. We addressed treatment selection biases using conventional Cox regression, propensity-stratified Cox regression (propensity score), and 2 forms of marginal structural models. Models accounted for multiple potential clinical and demographic confounders, and sensitivity analyses compared findings by antidepressant class.
  
  
  RESULTS
  Antidepressant medication use compared with no use was associated with significantly lower hazards of 1-year mortality risk in Cox (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.90-0.97) and propensity score estimates (HR, 0.94; 95% CI, 0.91-0.98), whereas marginal structural model-based estimates showed no difference in mortality risk when the exposure was specified as "as-treated" in every 90-day intervals of the 1-year follow-up (HR, 0.91; 95% CI, 0.66-1.26) but showed increased risk when specified as "intent-to-treat" (HR, 1.07; 95% CI, 1.02-1.13).
  
  
  CONCLUSIONS
  Among patients treated with ADMs belonging to a single class in the first 90 days, there were no significant differences in 1-year all-cause mortality risks. When accounting for clinical and demographic characteristics and treatment selection bias, ADM use was associated with no excess harm.
authors: From the *Department of Veterans Affairs, Center for Clinical Management Research; †Department of Psychiatry, University of Michigan Medical School; ‡Department of Health Management and Policy, University of Michigan School of Public Health; §Institute for Social Research and ‖Center for Statistical Consultation and Research, University of Michigan; and ¶Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI; #VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, VA Medical Center, Bedford; and **Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA; and ††Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors: Kara
authors: K
authors: Zivin
authors: H Myra
authors: HM
authors: Kim
authors: Matheos
authors: M
authors: Yosef
authors: Donovan T
authors: DT
authors: Maust
authors: Marcia
authors: M
authors: Valenstein
authors: Eric G
authors: EG
authors: Smith
authors: Dimitry S
authors: DS
authors: Davydow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012306:Risk; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents