Comparative Mortality Risk in Adult Patients With Schizophrenia, Depression, Bipolar Disorder, Anxiety Disorders, and Attention-Deficit/Hyperactivity Disorder Participating in Psychopharmacology Clinical Trials

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease

“…There is no doubt these are undesirable side effects in a population with increased risk of CVD; however, it is important to acknowledge that despite the clear evidence regarding CVD risk factors, evidence that these medications cause increases in CVD or CVD mortality is lacking to date. 231,252 Reasons for this discrepancy are uncertain; however, compelling contradictory findings regarding high-potency statins (decreased risk of CVD despite increased risk of T2DM) suggest that this discrepancy is not unique to psychiatric medications. 253 Pending definitive studies on this topic, one might speculate that the anti-inflammatory effects of these medications, or other yet unknown pharmacological properties, may partially mitigate their adverse effects on traditional CVD risk factors.…”

“…231 Tricyclic antidepressant drugs are not indicated for the treatment of mood disorders among youth and are not commonly used in this population, whereas selective serotonin reuptake inhibitors (SSRIs) are the pharmacological treatment of choice for depression among youth. 232 The topic of SSRIs and CVD has been examined in great detail among adults, and the current literature suggests that SSRIs may have a salutary effect on CVD (particularly citalopram and sertraline) and are unlikely to have a deleterious effect 231,233 ; however, there is evidence that SSRIs may confer a risk of obesity and possibly glycemic control problems. 234,235 This topic has received limited attention among youth to date.…”

Antipsychotics and mortality in a nationwide cohort of 29,823 patients with schizophrenia

“…Our results are in line with all previous large observational cohort studies (Tiihonen et al, Table 1 The mortality rates during monotherapy of specific antipsychotics among the prevalent and incident cohorts. 2006, 2011, 2012Baandrup et al, 2010, Crump et al, 2013: Vanasse et al, 2016 and meta-analyses on RCTs (Baxter et al, 2016;Khan et al, 2007Khan et al, , 2013. The lowest risk of death was observed during those time periods when patients used second generation LAIs, both in the prevalent and incident cohorts.…”

“…A systematic review suggested that gap in mortality compared with general population is even worsening and may be related to second generation antipsychotic use (Saha et al, 2007). Meta-analysis and systematic reviews of randomized controlled trials (RCTs) suggest that this is not the case, since mortality is lower during use of antipsychotics than during placebo (Baxter et al, 2016;Khan et al, 2007Khan et al, , 2013. However, these trial results have been criticized because the duration of treatments is usually substantially longer for active than placebo arms.…”

Utilizing Pharmacogenetics in Psychiatry: the Time Has Come

“…Their analysis supported previous studies, which showed that having a psychiatric diagnosis itself increases the overall mortality risk. However, the authors found that the mortality risk was not increased when patients were assigned to psychotropic agents rather than placebo, with the exception of heterocyclic antidepressants [8].…”